Bartholin Gland Diseases Clinical Presentation

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

History

Patients with cysts may present with painless labial swelling. Abscesses may present spontaneously or after a painless cyst with the following symptoms:

  • Acute, painful unilateral labial swelling

  • Dyspareunia

  • Pain with walking and sitting

  • Sudden relief of pain followed by discharge (highly suggestive of spontaneous rupture)

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Physical

The following physical examination findings are seen in Bartholin abscess, as shown in the image below.

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

See the list below:

  • Patients typically have an exquisitely tender, fluctuant labial mass with surrounding erythema and edema.

  • In some cases, areas of cellulitis surrounding the abscess may be present.

  • Fever, though not typical in healthy patients, may occur.

  • If the abscess has spontaneously ruptured, purulent discharge may be noted. If completely drained, no obvious mass may be observed.

The following physical examination findings are seen in Bartholin cysts:

  • Patients may have a painless, unilateral labial mass without signs of surrounding cellulitis.

  • If large, the cyst may be tender.

  • Discharge from ruptured cyst should be nonpurulent.

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Causes

Uncomplicated Bartholin cysts are filled with nonpurulent mucous. Several studies have aimed to identify the most common bacterial pathogens responsible for Bartholin abscess formation. Studies from the 1970-1980s named Neisseria gonorrhoeae and Chlamydia trachomatis as common pathogens . More recent studies report the predominance of opportunistic bacteria such as Staphylococcus species, Streptococcus species, and, most commonly, Escherichia coli. [7]

In a retrospective study by Kessous et al, a substantial percentage of patients with Bartholin gland abscess were culture-positive, with E coli being the single most common pathogen (43.7%), and 10 cases (7.9%) were polymicrobial. Culture-positive cases were significantly associated with fever, leukocytosis, and neutrophilia. Infection with E coli was significantly more common in recurrent infection than in primary infections (56.8% compared with 37%). [12]

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Complications

The most common complication of treatment of Bartholin abscess is recurrence. Rare case reports exist of necrotizing fasciitis after abscess drainage.

A theoretical risk exists for development of toxic shock syndrome with packing.

Nonhealing wounds may occur. Bleeding, especially in patients with a coagulopathy, may be a complication.

Cosmetic scarring may result.

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