Trauma or infection may involve the Bartholin duct, causing obstruction of the gland. Drainage of secretions is prevented, leading to pain, swelling, and abscess formation (Figure 18–1).
Right-sided Bartholin cyst (abscess). The Bartholin gland is located in the lower two-thirds of the introitus. (From Susan Lindsley, Public Health Image Library, CDC.)
The principal symptoms are periodic painful swelling on either side of the introitus and dyspareunia. A fluctuant swelling 1–4 cm in diameter lateral to either labium minus is a sign of occlusion of a Bartholin duct. Tenderness is evidence of active infection.
Purulent drainage or secretions from the gland should be cultured for Chlamydia and other pathogens and treated accordingly (see Chapter 33); frequent warm sitz baths may be helpful. All cysts and abscesses greater than 3 cm should undergo incision and drainage with additional efforts to keep the drainage tract open (eg, Word catheter or marsupialization). Marsupialization should be considered for recurrence after two prior Word catheters placements. Antibiotics are unnecessary unless cellulitis is present. In women under 40 years of age, asymptomatic cysts do not require therapy; in women over age 40, biopsy or removal are recommended to rule out vulvar carcinoma.
Surgical therapy (marsupialization) is indicated.