Bartholin Gland Diseases

Updated: Aug 10, 2017
  • Author: Antonia Quinn, DO; Chief Editor: Erik D Schraga, MD  more...
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Overview

Practice Essentials

The Bartholin glands are paired glands approximately 0.5 cm in diameter and are found in the labia minora in the 4- and 8-o’clock positions. Typically, they are nonpalpable. Each gland secretes mucus into a 2.5 cm duct. These two ducts emerge onto the vestibule at either side of the vaginal orifice, inferior to the hymen. Their function is to maintain the moisture of the vaginal mucosa's vestibular surface. This article focuses on the most common Bartholin gland diseases, cysts and abscesses (see the image below). Although rare, carcinoma of the gland should be considered in women with an atypical presentation. Primary carcinoma of the Bartholin gland accounts for approximately 5% of vulvar carcinomas. [1, 2, 3, 4, 5]

Patients typically have an exquisitely tender, fluctuant labial mass with surrounding erythema and edema. Patients may have a painless, unilateral labial mass without signs of surrounding cellulitis. Bartholin abscesses are very rarely caused by sexually transmitted pathogens.

A patient whose presentation is concerning for malignancy should receive close outpatient gynecologic follow-up for biopsy and possible excision. Those with an uncomplicated, asymptomatic cyst may be discharged with sitz bath instructions. Sitz baths (3 times daily) for several days may promote improvement with resolution or spontaneous rupture with resolution of the cyst.

A Bartholin abscess is generally painful, and, thus, usually requires incision and drainage. In one study, Word catheter treatment was successful in 26 of 30 cases (87%) of Bartholin cyst or abscess. [6]  Patients with an abscess often feel immediate pain relief after the drainage procedure; however, they may require oral analgesia for several days after the procedure. [7, 8]

Medications used in the treatment of Bartholin abscesses include topical and local anesthetics. Antibiotics for empiric treatment of STDs are advisable in the doses usually used to treat gonococcal and chlamydial infections. Ideally, antibiotics should be started immediately prior to incision and drainage.

Bartholin abscess. (Image courtesy of Dr. Gil Shla Bartholin abscess. (Image courtesy of Dr. Gil Shlamovitz.)
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Pathophysiology

Bartholin glands are known to form cysts and abscesses in women of reproductive age. Cysts and abscesses are often clinically distinguishable. Bartholin cysts form when the ostium of the duct becomes obstructed, leading to distention of the gland or duct with fluid. Obstruction is usually secondary to nonspecific inflammation or trauma. The cyst is usually 1-3 cm in diameter and often asymptomatic, although larger cysts may be associated with pain and dyspareunia. [1, 2, 9, 10]

Bartholin abscesses result from either primary gland infection or infected cyst. Patients with abscesses complain of acute, rapidly progressive vulvar pain. Studies have shown that these abscesses are usually polymicrobial and rarely attributable to sexually transmitted pathogens.

Adenocarcinoma of the Bartholin glands is rare, accounting for 1-2% of all vulvar malignancies. Typically, this lesion presents as a gradually enlarging gland in an asymptomatic, postmenopausal woman. [3]

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Epidemiology

Approximately 2% of women of reproductive age will experience swelling of one or both Bartholin glands. [11]

Bartholin gland diseases are rarely complicated by systemic infection, sepsis, and bleeding secondary to surgical treatment. Missed diagnosis of malignancy may result in poorer outcome for those patients.

These diseases typically occur in women between the ages of 20 and 30 years. Bartholin gland enlargement in patients older than 40 years is rare and should be referred to a gynecologist for possible biopsy.

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Prognosis

If abscesses are properly drained and reclosure is prevented, most abscesses have a good outcome.

Recurrence rates are generally reported to be less than 20%.

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Skin, Hair, and Nails Center and Women's Health Center. Also, see eMedicineHealth's patient education article Bartholin Cyst.

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