Bartholin Glands

Definition | Aetiology of Bartholin's Cyst and Abscess | Clinical Presentation | Investigations | Management | When to Refer | References

Definition

The Bartholin glands are a pair of small, pea-sized glands located on either side of the vaginal opening. Their primary function is to secrete mucus to lubricate the vagina. The glands themselves are usually not palpable unless they are blocked or infected, leading to the formation of a Bartholin's cyst or abscess.

Aetiology of Bartholin's Cyst and Abscess

A Bartholin's cyst forms when the duct of a Bartholin gland becomes blocked, causing fluid to accumulate. If the cyst becomes infected, it can develop into a Bartholin's abscess. Common causes include:

• Ductal Obstruction: The blockage of the Bartholin gland duct may be due to mucus, epithelial debris, or inflammation.
• Bacterial Infection: Infected cysts can result from a variety of bacteria, including Escherichia coli, Staphylococcus aureus, and sexually transmitted infections like Neisseria gonorrhoeae and Chlamydia trachomatis.
• Recurrent Infections: Repeated infections can lead to scarring and further obstruction of the duct, increasing the risk of cyst formation and abscess development.

Clinical Presentation

Symptoms vary depending on whether a cyst or abscess is present:

Bartholin's Cyst

• Painless Swelling: A Bartholin's cyst typically presents as a painless, unilateral swelling near the vaginal opening.
• Discomfort: Some women may experience discomfort, particularly during walking, sitting, or sexual intercourse.
• Size Variation: The cyst can vary in size, from a small, barely noticeable lump to a larger swelling that can cause significant discomfort.

Bartholin's Abscess

• Painful Swelling: An abscess is usually acutely painful and tender, with swelling that is often red and warm to the touch.
• Difficulty Walking or Sitting: The pain may be severe enough to interfere with walking, sitting, or sexual intercourse.
• Fever: Some women may develop a fever or feel generally unwell, indicating a systemic infection.
• Pus Discharge: If the abscess ruptures, there may be a discharge of pus from the area.

Investigations

The diagnosis of a Bartholin's cyst or abscess is primarily clinical, based on the history and physical examination. However, additional investigations may be warranted in certain cases:

• Pelvic Examination: A thorough examination to assess the size, location, and tenderness of the swelling. The healthcare provider will also check for signs of infection or other vulvar abnormalities.
• Microbiological Swabs: If an abscess is present, swabs may be taken to identify the causative organism and guide antibiotic therapy.
• Biopsy: In women over 40 or if there is any concern about malignancy (e.g., if the swelling is solid or atypical), a biopsy may be performed to rule out vulvar cancer.

Management

The treatment of a Bartholin's cyst or abscess depends on the severity of symptoms and whether infection is present:

Bartholin's Cyst

• Watchful Waiting: Small, asymptomatic cysts may not require treatment and can be monitored for changes.
• Warm Sitz Baths: Sitting in a warm bath several times a day may help the cyst to drain naturally and reduce discomfort.
• Incision and Drainage (I&D): If the cyst becomes large or symptomatic, I&D may be performed to relieve symptoms and prevent infection.

Bartholin's Abscess

• Incision and Drainage (I&D): The first-line treatment for an abscess, usually performed under local anaesthesia. A small incision is made to drain the pus, and a word catheter may be inserted to keep the area open and allow continuous drainage.
• Antibiotics: May be prescribed if there is significant infection, particularly if there are systemic symptoms or if the patient is immunocompromised. Empirical antibiotics are often used initially, with adjustments based on culture results if necessary.
• Word Catheter Placement: A small tube is inserted after I&D to keep the duct open, allowing it to drain and heal over time. The catheter is usually left in place for 4-6 weeks.
• Marsupialisation: A surgical procedure in which the cyst or abscess is opened and the edges are sutured to form a permanent opening, reducing the risk of recurrence.

When to Refer

Referral to a gynaecologist or specialist is warranted in the following situations:

• Recurrent Bartholin's cysts or abscesses that do not respond to standard treatment.
• Concerns about malignancy, particularly in women over 40 or if the swelling is atypical.
• Persistent symptoms despite appropriate management, or if there are complications such as extensive infection or severe pain.

References

1. NHS (2024) Bartholin's Cyst. Available at: https://www.nhs.uk/conditions/bartholins-cyst/ (Accessed: 26 August 2024).
2. Royal College of Obstetricians and Gynaecologists (2024) Management of Bartholin's Cyst and Abscess. Available at: https://www.rcog.org.uk/guidance/bartholins-cyst-management/ (Accessed: 26 August 2024).
3. British Medical Journal (2024) Bartholin's Cyst and Abscess: Clinical Review. Available at: https://www.bmj.com/content/350/bmj.h2275 (Accessed: 26 August 2024).

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