Module
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- Glands composed of columnar cells that secrete mucous
- Openings in the groove between the hymen and labia minora
- Located at approximately 5 and 7 o'clock at the vulvar vestibule, bilaterally
- Bulbospongiosus muscle and fascia overly these glands superficially
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- Result from obstruction of the opening of the glands
- Obstruction leads to accumulation of secretions
- Accumulation can be a nidus for infection, causing a Bartholin gland abscess (typically polymicrobial)
- Lifetime risk 2%
- Usually caused by opportunistic bacteria, most commonly Escherichia coli
- Occasionally caused by sexually transmitted bacteria, particularly in adolescents
- Previous abscess is a risk for recurrence
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- Cysts are typically 1-4 cm, often asymptomatic
- Larger cysts: vaginal pressure, dyspareunia, pain that limits walking or sitting
- Abscess: rapid vulvar enlargement (typically unilateral), pain, fever, fluctuant mass
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- Bartholin gland cyst:
- Asymptomatic --> No treatment necessary, conservative measures
- Symptomatic --> Word catheter or marsupialization
- Bartholin gland abscess:
- Drainage via Word catheter or marsupialization is preferred
- Addition of antibiotics for systemic symptoms or if concurrent cellulitis
- Testing for gonorrhea and chlamydia in adolescents or patients at increased risk
- Consider antibiotics as first-line therapy for immature abscess
- Indications for excision of gland
- Recurrent abscesses
- Solid masses
- Suspicion for malignancy
- Women > 40 years of age with Bartholin gland cyst or abscess should have a cyst wall biopsy given increased risk of malignancy
- Bartholin gland cyst:
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- Similar recurrence rate
- Word catheter advantages:
- Less need for analgesia
- Smaller incision
- Shorter procedure
- Marsupialization preferred for:
- Recurrent cysts that failed other methods
- Larger cyst/abscess
- Latex allergy (though can consider 14F Foley in lieu of Word catheter)
* Some studies have found slightly higher risk of hematoma, scaring and superimposed infection with marsupialization, others have found no difference.
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- Risks:
- Recurrence (5-15%) and need for additional procedures
- Rare complications:
- Dyspareunia
- Deep tissue infection
- Rectovaginal fistula
- Scarring
- Bleeding
- Hematoma formation
- Benefits:
- Resolution of discomfort and/or infection
- Risks:
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- Place patient in standard lithotomy position.
- Vaginal/vulvar prep.
- Skin incision: 2 - 3 cm incision on skin overlying the cyst, parallel to the hymen, with a #15 or #11 scalpel blade.
- Cyst wall incision: vertical incision to open the cyst wall.
- Open up cyst wall: place Allis clamps on superior, inferior, right, and left lateral wall cyst edges and cavity opened/drained.
- If abscess, collect cultures of purulent drainage.
- Cavity exploration with cotton swab, +/- cyst biopsy.
- Wound closure: suture cyst wall edges to adjacent skin edges using interrupted sutures with 2.0 or 3.0 delayed-absorbable suture.
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- Simple cyst drainage: no antibiotics needed
- Abscess drainage: 7-day course of antibiotics if concomitant cellulitis (TMP-SMX, doxycycline, or cephalexin)
- Consider admission and IV antibiotics for immunocompromised patients
- Cold packs for initial 24 hours
- Sitz baths 1-2x daily after 24 hours
- Resume activities as tolerated
- Delay sexual intercourse until healing complete
- 1 week post-operative visit
References
- Gershenson D, Lentz G, Valea F, Lobo R. Genital tract infection: Vulva, Vagina, Cervix, Toxic Shock Syndrome, Endometritis, and Salpingitis. Comprehensive Gynecology. 8th ed. Elsevier, Inc; 2022.
- Handa VL, Van Le L, eds. Surgery for Benign Vulvar Conditions. Te Linde’s Operative Gynecology. 12th ed. Wolters Kluwer; 2020.
- Hoffman BL, Schorge JO, Halvorson LM, Hamid C, Corton M, Schaffer JI. Benign Disorders of the Lower Reproductive Tract. Williams Gynecology. 4th ed. McGraw-Hill companies; 2020.
- Illingworth B, Stocking K, Showell M, Kirk E, Duffy J. Evaluation of treatments for Bartholin’s cyst or abscess: a systematic review. BJOG: Int J Obstet Gy. 2020;127(6):671-678.
- Rotem R, Diamant C, Rottenstreich M, et al. Surgical Treatment of Bartholin’s Gland Abscess: Is Word Catheter Superior to Marsupialization? Journal of Minimally Invasive Gynecology. 2021;28(6):1211-1215.
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