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