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Bartholin gland cysts and abscesses are common problems for women of reproductive age with an incidence of 2 percent in this population.1,2 A Bartholin gland and its duct may enlarge to form a Bartholin cyst or become infected and form a Bartholin abscess. A number of different techniques have been developed for the treatment of both cysts and abscesses.

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The Bartholin glands were named after Caspar Bartholin, a Danish anatomist.1,3 It refers to a pair of pea sized vulvovaginal mucous-secreting vestibular glands. They are located in the labia minora beneath the bulbospongiosus muscle, superficial to the deep perineal compartment, and in the 4 and 8 o’clock positions.4,5 The glands are lined with mucous-secreting epithelium that provides moisture for the vulva but are not necessarily needed for sexual lubrication.3,6 They drain by a 2.5 cm duct lined proximally with mucous-secreting epithelium and distally with transitional epithelium. The duct exits between the hymenal ring and the labia minora. The distal duct lining becomes squamous epithelium as it terminates.2,5,7 The Bartholin glands are not normally palpable.

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Obstruction of the duct by scar tissue, accumulation of secretions, metaplasia, trauma, or tumor leads to ductal dilation and cyst formation. Cysts may grow as large as 1 to 3 centimeters. Bartholin cysts present as painless unilateral swellings in the labial area. A patient will become symptomatic if they become large enough (some have been documented to be as large as 8 cm) or infected. Patients may complain of vulvar discomfort or pain with activity, sitting, and intercourse.3,6,8–10 The infected Bartholin gland may be tender, red, hot, and cellulitic.

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Carcinoma should be considered in the differential diagnosis of any labial mass. Adenocarcinoma (40 percent), squamous cell carcinoma (40 percent), adenoid cystic carcinoma (15 percent), and transitional cell carcinoma (5 percent) of the Bartholin gland have all been documented.5,7,11–13 Carcinoma can easily mimic a Bartholin gland cyst or abscess.

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The majority of Bartholin gland cysts appear to be sterile or contain bacteria common to the vaginal flora.14 Studies of Bartholin gland abscesses have shown no bacterial growth in 7, 10, and 30 percent of specimens cultured.14–16 The causative organisms are multiple in the cultures that do grow bacteria. Brook identified 67 different bacterial isolates from 26 different specimens.15 The most prevalent organisms isolated were anaerobes, with Bacteroides and Peptostreptococcus being the most common species. The remainder of the cultures demonstrated either aerobic/facultative isolates with Escherichia coli being the most common species or a mixture of both aerobic and anaerobic organisms. Neisseria gonorrhea and Chlamydia trachomatis have also been implicated as causative agents and have been isolated in 8 to 16 percent of cultures.14,17

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Small and asymptomatic cysts in women less than 40 years of age can be ...

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