Bartholins Cyst or Abscess

Last updated 10.08.12

 

Definition

-  Cystic dilation with or without abscess formation of Bartholin gland

 

Cyst

 

Features

-  Bartholins gland typically 0.5cm w 2.5cm long duct

-  Ducts open onto vestibule at 4 & 8 oclock, inferior to hymenal ring

-  Usually not palpable

-  Incidence 2% of women

-  Cyst

-  Range in size 1-3cm

-  Usually unilateral & asymptomatic

-  Abscess

-  Infected cyst

 

Risk Factors

-  Single

-  Low socioeconmic background

 

Causes

-  Cyst

-  Bartholin gland duct becomes obstructed & mucus accumulates leading to cystic dilation

-  Local or diffuse vulvar oedema

-  Abscess

-  Polymicrobial: E. Coli, Staph, Strep, Bacteroides

-   +/- N. Gonorrhoea, C. Trichomatis

 

DDx

-  Carcinoma (rare)

-  Usually >60yrs

-  <5% of all vulval Ca

-  Adenocarcinoma or SCC

 

Associated S/S

-  Cysts usually asymptomatic

-  Larger cysts may cause dysparaenia

-  Soft, painless mass

-  Abscess

-  Severe pain, unable to walk, sit or have intercourse

-  Warm, tender, soft, fluctuant, posterior labial mass

-  Unilateral in lower third of introitus between vestibule & labia majora

-  May expand anteriorly

-  +/- cellulitis

-  +/- pointing & D/C from abscess

-  +/- vaginal D/C esp if N. Gonorrhoea or C. Trichomatis

 

Ix

-  Vitals

-  Fever: uncommon

-  Sepsis unusual

-  Bx if >40yrs old or suspicious features

-  Abscess culture for MCS

-  Guide Abx cover as indicated

-  +/- urine PCR for N. Gonorrhoea & C. Trichomatis

 

Mx

-  Cysts

-  If asymptomatic nil Mx 

-  If >40: excise + Bx to exclude Ca

-  Abscess

-  Analgesia until surgical Mx

-  Immedite pain relief w excision

-   Incision & drainage: high risk of recurrence

-   Marsupialisation: <20% recurrence rate

-   New ductal orifice created via 1-2cm elipse incision

-   Incision at vestibule superficial to hymenal ring

-   Proximal duct wall everted & sutured

-   LA, pudendal block, GA

-  If ruptured spontaneously PO analgesia +/- warm compress/Sitz baths

-  Abx if septic or confirmed N. Gonorrhoea or C. Trichomatis

-   Augmentin Duo Forte BD

-   OR Cephalexin 500mg QID + Metronidazole 400mg TDS

 

Marsupialisation

Marsupialisation of a Bartholins cyst/abscess

 

 

 

References

 

Upto Date: Disorders of Bartholin Gland, Chen. K, Feb 02 2012

Pic (Marsupialisation)

Pic (Cyst)

Best Practice & Research Clinical Obstetrics and Gynaecology, Bartholins, Vulval & Perineal Abscesses, 2009