Trauma or infection may involve the Bartholin duct, causing obstruction of the gland. Drainage of secretions is obstructed, leading to pain, swelling, and abscess formation (Figure 18–1).
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, usually 1–4 cm in diameter lateral to either labium minus, is a sign of occlusion of a Bartholin duct. Tenderness is suggestive of active infection.
Purulent drainage or secretions from the gland should be tested for Neisseria gonorrhoeae, Chlamydia trachomatis, and other pathogens, and treated accordingly (see Chapter 33); frequent warm sitz baths may be helpful. Abscesses or cysts that are symptomatic 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. Antibiotics are unnecessary unless cellulitis is present. In women under 40, asymptomatic cysts do not require therapy; in women over age 40, biopsy or removal should be considered to rule out vulvar carcinoma.
When surgical therapy (marsupialization) is indicated.
et al. Management of Bartholin duct cysts and gland abscesses. J Midwifery Womens Health. 2019;64:337.
et al. Bartholin duct cyst and gland abscess: office management. Am Fam Physician. 2019;99:760.