Bartholin Duct Cyst & Abscess

Key Features

• Trauma or infection may cause obstruction of the gland; drainage of secretions is prevented, leading to pain, swelling, and abscess formation

• The infection usually resolves and pain disappears, but stenosis of the duct outlet with distention often persists

• Reinfection causes recurrent tenderness and further enlargement of the duct

Clinical Findings

• Periodic painful swelling on either side of the introitus and consequent dyspareunia

• A fluctuant swelling 1–4 cm in diameter lateral to either labium minus is a sign of occlusion of Bartholin duct

• Tenderness is evidence of active infection

Diagnosis

• Pus or secretions from the gland should be cultured for Chlamydia and other pathogens

Treatment

• Treat according to culture results

• Frequent warm soaks may be helpful

• If an abscess develops, aspiration or incision and drainage are the simplest forms of therapy, but the problem may recur

• Marsupialization (in the absence of an abscess), incision and drainage with the insertion of an indwelling Word catheter, or laser treatment will establish a new duct opening. Antibiotics are unnecessary unless cellulitis is present

• An asymptomatic cyst does not require therapy

• 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