Bartholin gland cyst and abscess
Obstruction of the Bartholin duct causes a cystic swelling at the medial labia majora that becomes an acutely painful, fluctuant abscess when the trapped mucus is secondarily infected; symptomatic disease is treated with drainage, preferably Word catheter placement or marsupialization, rather than antibiotics alone.
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What this article covers
- Overview
Cystic dilation of an obstructed Bartholin duct: the paired Bartholin (greater vestibular) glands sit just inside the vaginal introitus at approximately the 4 and 8 o'clock positions; obstruction of…
- Epidemiology
Reproductive-age females: the condition is essentially confined to women of reproductive age, correlating with the period of maximal glandular secretory activity.
- Risk factors
Prior Bartholin duct obstruction or cyst: a duct that has scarred or narrowed from a previous episode is prone to recurrent obstruction.
- Pathophysiology
Ductal obstruction: the Bartholin duct becomes blocked, most often near its distal opening into the vestibule.
- Clinical features
Unilateral labial mass, often asymptomatic when a simple cyst: a smooth, mobile, non-tender to mildly tender fluctuant mass near the vaginal introitus, most often noticed incidentally or on routine exam.
- Differential diagnosis
Vulvar or vaginal abscess of another source (for example an infected sebaceous or epidermoid cyst): lacks the characteristic 4 or 8 o'clock ductal location; see epidermoid-epidermal-inclusion-cyst.
- Diagnosis
Clinical diagnosis established by inspection and palpation: there is no formal diagnostic criteria set; the diagnosis is made on physical examination by identifying a mass at the medial labia majora…
- Management
First, decide simple cyst versus abscess on exam, since this determines whether drainage is needed at all.
- Complications
Recurrence: the most common complication, especially after simple incision and drainage without a Word catheter or marsupialization, because the duct reobstructs once the tract closes.
- Prognosis
Excellent with appropriate drainage: simple cysts that are asymptomatic require no intervention and resolve or remain stable without sequelae.
- Prevention
No proven primary prevention: there is no established screening interval or prophylactic measure that prevents initial Bartholin duct obstruction.
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