Bartholin gland cysts are mucus-filled and found within the labia majora, posterolateral to the vaginal opening. Cysts form secondary to Bartholin gland duct obstruction and can become infected, leading to abscess. Infection is usually with mixed vaginal or fecal flora (Escherichia coli) but may also contain N gonorrhoeae and C trachomatis. Cysts may be asymptomatic, whereas abscesses are usually erythematous and swollen and may cause dyspareunia. A tender, fluctuant, cystic mass with surrounding labial edema is easily appreciated on examination. Differential should include epidermal inclusion cysts and sebaceous cysts of the labia majora, hidradenitis suppurativa, vulvar hematomas, leiomyomas, lipomas, and fibromas.
Management and Disposition
Simple incision and drainage followed by sitz baths is the most effective immediate treatment, but recurrence of cysts is common. Placement of a Word catheter into the cyst cavity decreases the incidence of reocclusion. The catheter, however, must remain in place up to 6 weeks to ensure epithelialization.
Bartholin Gland Cyst. Bartholin gland cyst that is not infected. The labia minoris lays over the middle of the cyst. (Photo contributor: Hope Haefner, MD.)
Bartholin Gland Abscess. Bartholin gland abscess with the labial fluctuance pointing medially. (Photo contributor: Medical Photography Department, Naval Medical Center, San Diego, CA.)
Antibiotics are usually not required after incision and drainage.
Incise the internal (medial) surface of the cyst or abscess rather than the external (lateral) aspect, as the incision site may become the new drainage tract.
Refer recurrent abscesses to gynecologist for definitive treatment, which may involve marsupialization of the gland.
Bartholin Gland Abscess. Medial incision of the cyst yielding purulent fluid, consistent with a Bartholin gland abscess. (Photo contributor: Medical Photography Department, Naval Medical Center, San Diego, CA.)
Bartholin Gland Abscess. Insertion and inflation of a Word catheter into the cyst cavity. The free end of the catheter can be tucked into the vagina for long-term placement, allowing for epithelialization of the incision site. (Photo contributor: Medical Photography Department, Naval Medical Center, San Diego, CA.)