Bartholin gland cysts and abscesses are common problems for women of reproductive age with an incidence of 2% in this population.1-4 A Bartholin gland and its duct may enlarge to form a Bartholin cyst or become infected to form a Bartholin abscess. A number of different techniques have been developed for the treatment of Bartholin cysts and abscesses.
ANATOMY AND PATHOPHYSIOLOGY
The Bartholin glands are named after Caspar Bartholin, a Danish anatomist.1,5 They are located on each side of the vulvar vestibule beneath the fascia, posterolaterally to the vaginal orifice, and at the 4 and 8 o’clock positions.6,7 The glands are approximately 1 cm in diameter, the size of a pea, and drain through a duct approximately 2.5 cm in length. The ducts of the glands open into the vulvar vestibule at the 5 and 7 o’clock positions, existing between the hymenal ring and the labia minora. The cells of the gland produce mucin which is secreted during sexual excitement and contributes to vaginal lubrication.5,8 The Bartholin glands are not normally palpable. The gland has an extensive blood supply from branches of the internal pudendal artery. The neural supply is provided from branches of the pudendal nerve.
A cyst of the Bartholin gland may develop most often secondary to obstruction of the duct. This leads to ductal dilation and cyst formation. Noninfectious etiologies of cyst formation include inspissated gland secretions, trauma, tumors of the vulva, or scarring of the duct from repeated bouts of cyst formation.3 Cysts may grow as large as 3 cm. Bartholin cysts present as painless unilateral swellings in the labial area. A patient will become symptomatic if they become large enough or infected. Infected cysts contain purulent material and are known as a Bartholin abscess, although it is more akin to a pseudoabscess unless the surrounding tissue appears erythematous, tender, and inflamed.3 A Bartholin cyst may present with pain, dyspareunia, pressure, difficulty with walking, or may be completely asymptomatic.5,8-12 The diagnosis is made on visual inspection of the vulva. Common signs are a mass near the inferior labia minora, drainage, and erythema.
Primary carcinoma of the Bartholin gland is a rare occurrence but should be considered in the differential diagnosis. Most cancers occurring in the Bartholin gland are metastatic primary vulvar cancers. They can present as a Bartholin gland cyst when the vulvar cancer obstructs the ductal outflow of the gland. Adenocarcinoma (40%), squamous cell carcinoma (40%), adenoid cystic carcinoma (15%), and transitional cell carcinoma (5%) of the Bartholin gland have all been documented.7,13-20 Carcinoma can easily mimic a Bartholin gland cyst or abscess.
The majority of Bartholin gland cysts appear to be sterile or contain bacteria common to the vaginal flora.21-23 Studies of Bartholin gland abscesses have shown no bacterial growth in ...