Bartholin's Gland Abscess

Aka: Bartholin's Gland Abscess, Bartholin Gland Abscess, Bartholin's Abscess, Bartholin's Gland Duct Cyst, Bartholin's Gland Cyst, Bartholin Duct Cyst, Bartholin Cyst, Bartholin Gland, Word Catheter, Bartholin Gland Catheter, Jacobi Ring

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II. Epidemiology

  1. Bartholin's Gland Duct Cysts and abscess Incidence: 2%
  2. Most common in adult women under age 30 years

III. Pathophysiology

  1. Bartholin's Gland
    1. Homologues to male bulbourethral glands
    2. Vaginal vestibular glands provide moisture during arousal and intercourse
      1. Moisture is also provided by Skene glands
    3. Located at bilateral inferior labia minora
    4. Drain via 2 to 2.5 cm long ducts at 4:00 and 8:00 positions of labia
    5. Normal Bartholin's gland size <1 cm and not typically palpable
    6. Glands are lined by columnar epithelium, while ducts are lined by squamous epithelium
    7. Typically Bartholin Glands involute around 30 years old
  2. Bartholin's Gland Duct Cyst
    1. Results from distal duct obstruction, often from friction with intercourse
  3. Bartholin's Gland Abscess (more common than cysts)
    1. May occur spontaneously or as infection of duct cyst

IV. Causes: Bacterial (Abscess)

  1. Most common organisms
    1. Escherichia coli
    2. Staphylococcus Aureus
  2. Other common causes (increasing Incidence, may be related to oral sex)
    1. Streptococcus Pneumoniae
    2. Haemophilus Influenzae
  3. Sexually Transmitted Disease may also cause abscesses in the United States
    1. Chlamydia Trachomatis
    2. Neisseria gonorrhoeae
  4. Other causes
    1. Streptococcus faecalis
    2. Pseudomonas Aeruginosa
    3. Bacteroides fragilis
    4. Clostridium perfringens

V. Precautions

  1. Consider malignancy for Bartholin Gland cyst or abscess at age >40 years old

VI. Symptoms

  1. Vulvar Pain worse with walking and intercourse
  2. Fever may be present with abscess

VII. Signs

  1. Unilateral, firm swelling at posterior vaginal introitus
    1. Occurs at 5:00 and 7:00 positions (where Bartholin Gland ducts exit)
    2. Posterior labia minora affected

VIII. Labs

  1. Consider screening for Sexually Transmitted Disease (see causes above)
  2. Consider biopsy in women over age 40 years old

IX. Differential Diagnosis

  1. Cystic lesions
    1. Epidermal Inclusion Cyst (at labia majora)
    2. Skene's Duct cyst (at Urethral meatus)
    3. Cyst at Canal of Nuck (at labia majora, mons pubis)
      1. Hydrocele protruding through inguinal ring into the labia majora
      2. May also be associated with an Inguinal Hernia
      3. Presents as a translucent cyst in the labia, worse with standing and better supine
    4. Gartner Duct Cyst
      1. Wolfian duct (mesonephric duct) remnant results in vaginal inclusion cyst to either side of Urethra
    5. Hidradenoma papilliferum (between labia majora and labia minora)
    6. Mucous cyst of vestibule
  2. Solid lesions
    1. Cancerous growths
      1. More common over age 40 years old (esp. postmenopausal woman)
      2. Accounts for 5% of vulvar carcinomas
      3. Early detection prevents local invasion and metastases
      4. Types
        1. Squamous Cell Carcinoma of the Bartholin duct (associated with HPV 16)
        2. Adenocarcinoma of the Bartholin Gland
    2. Benign growths
      1. Acrochordon
        1. At labia majora
        2. Fleshy, polypoid, often pedunculated lesion
      2. Angiokeratoma
        1. Benign, rare, vascular lesions (esp. in pregnancy, Fabry Disease)
      3. Fibroma
        1. At labia majora, introitus, perineal body
        2. Firm swelling and typically asymptomatic
      4. Lipoma
        1. At Labia majora, clitoris
        2. May be pedunculated
      5. Leiomyoma
        1. At labia majora
        2. Rare, firm outgrowth from Smooth Muscle
      6. Neurofibroma
        1. Small, fleshy, polypoid lesion
        2. Associated with von Recklinghausen Disease

X. Management: Approach

  1. Asymptomatic Bartholin Gland cyst (and no abscess)
    1. Age <40 years: No treatment required
    2. Age >40 years: Biopsy
  2. Antibiotic indications
    1. Cellulitis with abscess
    2. Sexually Transmitted Infection
    3. Urinary Tract Infection
  3. Acute abscess or symptomatic cyst: Fistulization (create a new outflow tract, using techniques below)
    1. Word Catheter
    2. Jacobi Ring
  4. Recurrent Bartholin Cyst
    1. Marsupialization of Bartholin's Gland Cysts
    2. Alcohol Sclerotherapy
  5. Refractory Bartholin Cyst or age over 40 years old (cancer risk)
    1. Excision of of Bartholin's Gland Cyst
  6. Avoid low efficacy procedures with high recurrence rates
    1. Simple Incision and Drainage (without fistulization or marsupilization)
    2. Cyst needle aspiration (without sclerotherapy)

XI. Management: Word Catheter Placement for cyst or abscess (fistulization)

  1. Betadine prep or Hibiclens overlying abscess wall at labia
  2. Administer Local Anesthesia with Lidocaine 1%
  3. Make 5 mm stab incision over abscess with #11 blade
    1. Incision should be oriented vertically
    2. Incision should lie outside hymenal ring
  4. Insert Word Catheter into incision
    1. Inflate Word Catheter balloon with 2-3 cc saline
  5. Word Catheter remains in place for 4-6 weeks minimum
    1. Up to 3 months are required in some cases for adequate recanalization
    2. Balloon often spontaneously self-expels (consider suturing incision to hold in place)
  6. Video of technique
    1. https://www.youtube.com/watch?v=zyopxjyExtI

XII. Management: Jacobi Ring

  1. Preparation
    1. Catheter creation
      1. T Tube 8 french, cut a 7 cm length
      2. Butterfly catheter tubing, cut a 5 cm length
    2. Thread the catheter
      1. Silk Suture 2-0, 20 cm length
  2. Betadine prep or Hibiclens overlying abscess wall at labia
  3. Administer Local Anesthesia with Lidocaine 1%
  4. Make 5 mm stab incision over abscess with #11 blade
    1. Incision should be oriented vertically
    2. Incision should lie outside hymenal ring
  5. Use a hemostat to break adhesions within abscess
  6. Tunnel hemostat to superior pole of the abscess and back through the mucosa
    1. Incise over the surface of the hemostat
    2. Grasp one end of Jacobi Ring and pull through the original incision
  7. Tie the Suture ends

XIII. Management: Other measures (typically by Gynecology)

  1. Marsupialization of Bartholin's Gland Cysts
    1. Only use for recurrent cysts (contraindicated for abscess)
    2. Incision overlies the entire length of the cyst wall
    3. Cyst wall excised, irrigated with saline
    4. Cyst wall and mucosa are Sutured open with Absorbable Suture (Vicryl 2-0, 3-0)
    5. Start Sitz baths on day 1 and perform daily
    6. Re-evaluate at 4 weeks
    7. Technique Video
      1. https://www.youtube.com/watch?v=mqNmGMv815E
  2. Alcohol Sclerotherapy
    1. Silver Nitrate sclerotherapy may be used instead (but has a longer healing time)
    2. Aspirate the cyst with an 18-20 gauge needle until cyst wall collapses
    3. With the needle in place, reinject 70% Alcohol back into the cyst (similar volume of aspirated fluid)
    4. After 5 minutes, aspirate Alcohol from the cyst
    5. Expect healing within 1 week
  3. Excision of of Bartholin's Gland Cyst
    1. Indicated if refractory to other measures or age 40 years or older (cancer risk)
    2. Procedure timed when no infection present
    3. Refer to Gynecology or Surgery for procedure

XIV. References

  1. Apgar in Pfenninger (1994) Procedures p. 596-600
  2. Omole (2003) Am Fam Physician 68(1):135-40 [PubMed]
  3. Omole (2019) Am Fam Physician 99(12): 760-66 [PubMed]

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Ontology: Abscess of Bartholin's gland (C0004766)

Concepts Pathologic Function (T046)
ICD9 616.3
ICD10 N75.1
SnomedCT 67624004, 155983009
Italian Ascesso della ghiandola di Bartolini, Ascesso della ghiandola del Bartolini
Dutch abces van klieren van Bartholin, abces; glandula Bartholini, abces; vulvovaginale klier, vulvovaginale klier; abces, Abces van glandula Bartholini, abces van Bartholin, gl.Bartholini; abces
French Abcès de Bartholin, Abcès de glande de Bartholin, Abcès de la glande de Bartholin
German Abszess der Bartholin-Druese, Abszess Bartholin, Bartholin-Abszess, Abszess der Bartholin' Druese
Portuguese Abcesso das glândulas de Bartholin, Abcesso da glândula de Bartholin, Abcesso de Bartholin
Spanish Bartolinitis, absceso de la glándula de Bartolino (trastorno), absceso de la glándula de Bartolino, absceso de la glándula vestibular mayor, absceso de la glándula vulvovaginal, Absceso de la glándula de Bartholin
Japanese バルトリン腺膿瘍, ﾊﾞﾙﾄﾘﾝｾﾝﾉｳﾖｳ
English abscess of Bartholin's gland, Bartholin's gland abscess, abscess of Bartholin's gland (diagnosis), abscess of Bartholin's gland (physical finding), Abscess Bartholin's, Bartholin's glnd abscess, Abscess of Bartholin gland, bartholin's gland abscess, Abscess;Bartholin, abscess bartholins, bartholin's abscess, abscess bartholin gland, bartholin abscess, bartholin gland abscess, abscess bartholin, Abscess of Bartholin's gland, Vulvovaginal gland abscess, Bartholin's abscess, Abscess of Bartholin's gland (disorder), abscess; bartholin's gland, abscess; vulvovaginal gland, vulvovaginal gland; abscess, gl.Bartholin; abscess, Bartholins abscess
Czech Absces Bartholiniho žlázy
Korean 바르톨린샘의 고름집(농양)
Hungarian Bartholin mirigy tályog, Bartholin-tályog
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cyst of Bartholin's gland duct (C0004767)

Concepts Disease or Syndrome (T047)
ICD9 616.2
ICD10 N75.0
SnomedCT 57044006, 155982004, 27978000
LNC LP175662-8, MTHU047584
Italian Cisti della ghiandola di Bartolini, Cisti della ghiandola del Bartolini
Dutch Bartholincyste, Bartholin; cyste, cyste; Bartholin, cyste; glandula Bartholini, Cyste van glandula Bartholini, Bartholinische cyste, gl.Bartholini; cyste
French Kyste de glande de Bartholin, Kyste des glandes de Bartholin
German Zyste der Bartholin-Druese, Bartholin-Zyste
Portuguese Quisto da glândula de Bartholin, Quisto de Bartholin
Spanish Quiste de la glándula de Bartholin, quiste de la glándula de Bartolino (concepto no activo), quiste de la glándula de Bartolino, quiste de la glándula vestibular mayor, quiste del conducto de la glándula de Bartolino (trastorno), quiste del conducto de la glándula de Bartolino, quiste del conducto de la glándula vestibular mayor, Quiste de Bartolino
Japanese バルトリン嚢腫, バルトリン腺嚢腫, ﾊﾞﾙﾄﾘﾝｾﾝﾉｳｼｭ, ﾊﾞﾙﾄﾘﾝﾉｳｼｭ
English Cyst of Bartholin's duct, Bartholin gland cyst, Bartholin duct cyst, Bartholin duct cyst (diagnosis), Bartholin gland cyst (diagnosis), Bartholin Cyst, Bartholin's Cyst, Cyst of Bartholin gland duct, bartholin cyst gland, Cyst;Bartholin, bartholin cyst/abscess, bartholin cysts, bartholin gland cyst, abscesses bartholin cyst, bartholin's cyst, abscess bartholin cyst, bartholin cyst, bartholin cysts gland, bartholin's duct cyst, bartholins cyst gland, bartholins's cysts gland, bartholin's cysts, bartholin's cysts gland, bartholin's gland cyst, Cyst of Bartholin's gland (disorder), Bartholin cyst, Cyst of Bartholin's gland, Bartholin's gland cyst, Bartholin's cyst, Bartholin's gland duct cyst, Cyst of Bartholin's gland duct, Cyst of Bartholin's gland duct (disorder), cyst; Bartholin, cyst; bartholin's gland, Bartholin; cyst, gl.Bartholin; cyst, Bartholin's duct cyst, bartholins cyst
Czech Cysta bartholinské žlázy, Bartholinská cysta
Korean 바르톨린샘의 낭포
Hungarian Bartholin-cysta, Bartholin-mirigy cysta
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bartholin Glands (C0004768)

Definition (NCI) The two mucous secreting glands on either side of the vaginal opening.
Definition (MSH) Mucus-secreting glands situated on the posterior and lateral aspect of the vestibule of the vagina.
Concepts Body Part, Organ, or Organ Component (T023)
MSH D001472
SnomedCT 87176006, 181443008
HL7 BARTG
English Bartholin Glands, Bartholin's Glands, Bartholins Glands, Glands, Bartholin's, Bartholin gland, Tiedemann's gland, Duverney's gland, Glandula vestibularis major, Vulvovaginal gland, Bartholin's Gland, Bartholin Gland, Bartholin gland structure, bartholin's gland, greater vestibular gland, bartholin glands, bartholins glands, bartholin gland, glands major vestibular, bartholin's glands, bartholins gland, Bartholins gland, [SO]Bartholin gland, Major vestibular gland, Bartholin's gland, Greater vestibular gland, Bartholin's gland structure (body structure), Bartholin's gland structure
French Glandes de Duverney, Glandes de Tiedmann, Glandes de Bartholin, Glandes vestibulaires majeures, Glandes vulvo-vaginales, Glandes vulvovaginales
Swedish Bartholins körtlar
Czech Bartholiniho žlázy
Finnish Bartholinin rauhaset
Russian BARTOLINOVY ZHELEZY, БАРТОЛИНОВЫ ЖЕЛЕЗЫ
Croatian BARTHOLINOVA ŽLIJEZDA
Latvian Bartolīndziedzeri, Bartolīna dziedzeri
Polish Gruczoł przedsionkowy większy, Gruczoł Bartholina
Norwegian Glandulae vestibularis majores, Bartholinske kjertler, Bartholins kjertler
Spanish Glándula Vestibular Mayor, Glándula de Bartolino, Glándulas de Bartolino, Glandula Vestibularis Major, Glándula de Bartholin, Glándulas de Bartholin, estructura de la glándula de Bartolino (estructura corporal), estructura de la glándula de Bartolino, glándula de Bartolino, glándula vestibular mayor, Glándulas Vestibulares Mayores
Portuguese Glândula de Bartholin, Glandula Vestibularis Major, Glândula Vestibular Maior, Glândulas de Bartholin, Glândulas Vestibulares Maiores
German Glandulae vestibulares majores, Bartholin-Drüsen
Italian Ghiandole del Bartolini
Dutch Bartholini, klieren van, Glandulae vestibulares majores, Klieren van Bartholini
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Catheters, Bartholin's Gland (C0179719)

Definition (UMD) Catheters designed to form a passageway from either of the two small reddish glands (Bartholin's glands) on each side of the vaginal orifice to the space where the urethra and the vagina open (vaginal vestibulum). These catheters are short (e.g., 5 cm) plastic tubes; some catheters include a balloon at the tip to ensure retention within the gland. These catheters are used for drainage in the treatment of Bartholin's gland cysts and abscesses.
Concepts Medical Device (T074)
English Catheters, Bartholin's Gland, Bartholin's Gland Catheters
Derived from the NIH UMLS (Unified Medical Language System)

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