Bartholin Gland Diseases Treatment & Management
- Author: Antonia Quinn, DO; Chief Editor: Erik D Schraga, MD more...
Emergency Department Care
ED care should include a careful history and physical examination. 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. Several techniques have been described, but no large prospective studies have been performed to determine relative efficacy and complications. The goal of abscess treatment is to allow drainage and to prevent rapid reaccumulation of fluid. These techniques are described below. Refer to the Medscape Reference Clinical Procedures article Bartholin Abscess Drainage for Bartholin cyst management and further details.
Patient comfort is essential to successful drainage. Use adequate anesthesia when incising any abscess. Attempting to do so without anesthesia results in an uncooperative patient, reduces the likelihood of successful drainage, and is unconscionable. Apply topical anesthetics to the mucosa followed by submucosal injection of local anesthetic (the minimum pain control required). Conscious sedation is often required and may be desirable. In patients with a large or complex abscess or for a complicated procedure, general anesthesia in the operating room (OR) may be required.
In a study of patients with Bartholin gland carcinoma, high-dose-rate interstitial brachytherapy (HDR-ISBT) boost after external-beam radiation therapy (EBRT) was shown to provide excellent long-term local control. According to the authors, HDR-ISBT should be considered for positive surgical margins or residual tumor after surgery and for locally advanced malignancies treated by primary chemoradiotherapy.
Incision and drainage
This technique consists of traditional incision, drainage, irrigation, and packing. Packing should be removed 2 days after the procedure. This technique requires multiple, painful packing changes and has a higher rate of abscess recurrence.
Word catheter (shown in the image below)
The Word catheter was introduced in the 1960s. It is a small catheter with a saline inflatable balloon at the distal end. This procedure should be performed using sterile technique. In one study, Word catheter treatment was successful in 26 of 30 cases (87%) of Bartholin cyst or abscess. Using an #11 blade a 0.5-cm incision is made into the abscess cavity on the mucosal surface of the labia minora. Contents of the cavity are expressed manually or by hemostat. The tip of the catheter is inserted into the cavity, and the balloon is inflated with 4 mL normal saline, as shown in the image below.[6, 8]
The free end of the catheter may be inserted into the vagina for patient comfort. The catheter allows for abscess drainage acutely and is left in place for several weeks to promote fistula formation.
Patients should be advised to take sitz baths 2-3 times a day for 2 days following the procedure and to abstain from sexual intercourse until the catheter is removed. Simplicity is the technique's main advantage. It is tolerable to patients and allows restoration of gland function. A recent case report describes novel use of plastic tubing for abscess drainage when a Word catheter is not available.
This procedure is reserved for recurrent abscesses. The acute abscess is drained prior to marsupialization. This procedure consists of a wide incision of the mass followed by suturing the inner edge of the incision to external mucosa. This complicated procedure is usually performed by a gynecologist or urologist in the OR.
This procedure requires excision of the Bartholin gland and surrounding tissue. It is disfiguring, painful, and seldom indicated in the treatment of abscess, although it may be used to treat malignancy.
It should be performed only in the OR to ensure appropriate anesthesia.
Recent studies have examined the safety and efficacy of carbon dioxide laser therapy as well as alcohol sclerotherapy to treat Bartholin abscesses.[13, 14, 15] Early studies show promising results. In a recent study, the cure rate was nearly 96% with one laser treatment.
In another study of patients who received carbon dioxide laser therapy, the median operative time was 15 minutes (range, 12-35 minutes); median postoperative stay was 1 hour (range, 1-4 hours); and estimated 3-year relapse-free rate was 88.56%. Lesion wall thickness of 0.5-1.5 mm, multilocular lesions, and hyperechogenic lesions were correlated with recurrence.
Silver nitrate gland ablation has shown promise as a safe and effective treatment for both simple cysts and abscesses in a number of small studies.
Patients who present to the ED with Bartholin gland swelling rarely require emergent gynecologic consultation. Relative indications for consultation may include the following:
Complex or recurrent abscess requiring general anesthesia in the OR
Need for biopsy, usually due to concern for malignancy
Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A. Clinical Pathology of Bartholin's Glands: A Review of the Literature. Curr Urol. 2015 May. 8 (1):22-5. [Medline].
Heller DS, Bean S. Lesions of the Bartholin gland: a review. J Low Genit Tract Dis. 2014 Oct. 18 (4):351-7. [Medline].
Alsan CI, Vinh-Hung V, Eren F, Abacioglu U. Adenoid cystic carcinoma of the Bartholin's gland: case report and systematic review of the literature. Eur J Gynaecol Oncol. 2011. 32(5):567-72. [Medline].
Bhalwal AB, Nick AM, Dos Reis R, Chen CL, Munsell MF, Ramalingam P, et al. Carcinoma of the Bartholin Gland: A Review of 33 Cases. Int J Gynecol Cancer. 2016 May. 26 (4):785-9. [Medline].
Krissi H, Shmuely A, Aviram A, From A, Edward R, Peled Y. Acute Bartholin's abscess: microbial spectrum, patient characteristics, clinical manifestation, and surgical outcomes. Eur J Clin Microbiol Infect Dis. 2016 Mar. 35 (3):443-6. [Medline].
Reif P, Ulrich D, Bjelic-Radisic V, Häusler M, Schnedl-Lamprecht E, Tamussino K. Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs. Eur J Obstet Gynecol Reprod Biol. 2015 Jul. 190:81-4. [Medline].
Berger MB, Betschart C, Khandwala N, Delancey JO, Haefner HK. Incidental bartholin gland cysts identified on pelvic magnetic resonance imaging. Obstet Gynecol. 2012 Oct. 120(4):798-802. [Medline]. [Full Text].
Boama V, Horton J. Word balloon catheter for Bartholin's cyst and abscess as an office procedure: clinical time gained. BMC Res Notes. 2016 Jan 6. 9:13. [Medline].
Kessous R, Aricha-Tamir B, Sheizaf B, Steiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological characteristics of Bartholin gland abscesses. Obstet Gynecol. 2013 Oct. 122(4):794-9. [Medline].
Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv. 2009 Jun. 64(6):395-404. [Medline].
Thibault I, Lavallée MC, Aubin S, Jain S, Laflamme N, Vigneault É. Management of Bartholin's gland carcinoma using high-dose-rate interstitial brachytherapy boost. Brachytherapy. 2013 Sep-Oct. 12(5):500-7. [Medline].
Kushnir VA, Mosquera C. Novel technique for management of Bartholin gland cysts and abscesses. J Emerg Med. 2009 May. 36(4):388-90. [Medline].
de Góis Speck NM, Belfort PN, Mendes P, Kang HJ, Ribalta JC. Carbon dioxide laser treatment of Bartholin's gland cyst. Clin Exp Obstet Gynecol. 2007. 34(1):50-1. [Medline].
Benedetti Panici P, Manci N, Bellati F, Di Donato V, Marchetti C, Calcagno M, et al. CO2 laser therapy of the Bartholin's gland cyst: surgical data and functional short- and long-term results. J Minim Invasive Gynecol. 2007 May-Jun. 14(3):348-51. [Medline].
Frega A, Schimberni M, Ralli E, Verrone A, Manzara F, Schimberni M, et al. Complication and recurrence rate in laser CO2 versus traditional surgery in the treatment of Bartholin's gland cyst. Arch Gynecol Obstet. 2016 Aug. 294 (2):303-9. [Medline].
Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, et al. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol. 2008 May-Jun. 15(3):327-31. [Medline].
Di Donato V, Bellati F, Casorelli A, Giorgini M, Perniola G, Marchetti C, et al. CO2 laser treatment for Bartholin gland abscess: ultrasound evaluation of risk recurrence. J Minim Invasive Gynecol. 2013 May-Jun. 20(3):346-52. [Medline].
Aghajanian A, Bernstein L, Grimes DA. Bartholin's duct abscess and cyst: a case-control study. South Med J. 1994 Jan. 87(1):26-9. [Medline].
Eppel W, Frigo P, Worda C, Bettelheim D. Ultrasound imaging of Bartholin's cysts. Gynecol Obstet Invest. 2000. 49(3):179-82. [Medline].
Goldberg JE. Simplified treatment for disease of Bartholin's gland. Obstet Gynecol. 1970 Jan. 35(1):109-10. [Medline].
Heah J. Methods of treatment for cysts and abscesses of Bartholin's gland. Br J Obstet Gynaecol. 1988 Apr. 95(4):321-2. [Medline].
Kdous M, Hachicha R, Iraqui Y, Jacob D, Piquet PM, Truc JB. [Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess]. Gynecol Obstet Fertil. 2005 Nov. 33(11):887-90. [Medline].
Tanaka K, Mikamo H, Ninomiya M, Tamaya T, Izumi K, Ito K, et al. Microbiology of Bartholin's gland abscess in Japan. J Clin Microbiol. 2005 Aug. 43(8):4258-61. [Medline].
Wheelock JB, Goplerud DR, Dunn LJ, Oates JF 3rd. Primary carcinoma of the Bartholin gland: a report of ten cases. Obstet Gynecol. 1984 Jun. 63(6):820-4. [Medline].
Woida FM, Ribeiro-Silva A. Adenoid cystic carcinoma of the Bartholin gland: an overview. Arch Pathol Lab Med. 2007 May. 131(5):796-8. [Medline].
Wydra D, Klasa-Mazurkiewicz D, Emerich J, Milczek T. The problem of accurate initial diagnosis of Bartholin's gland carcinoma resulting in delayed treatment and aggressive course of the disease. Int J Gynecol Cancer. 2006 May-Jun. 16(3):1469-72. [Medline].