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Bartholin gland cysts are mucus-filled and found within the labia majora, posterolateral to the vaginal opening. Cysts form secondary to Bartholin gland duct obstruction and can become infected, leading to abscess. Infection is usually with mixed vaginal or fecal flora (Escherichia coli) but may also contain N gonorrhoeae and C trachomatis. Cysts may be asymptomatic, whereas abscesses are usually erythematous and swollen and may cause dyspareunia. A tender, fluctuant, cystic mass with surrounding labial edema is easily appreciated on examination. Differential should include epidermal inclusion cysts and sebaceous cysts of the labia majora, hidradenitis suppurativa, vulvar hematomas, leiomyomas, lipomas, and fibromas.
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Management and Disposition
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Simple incision and drainage followed by sitz baths is the most effective immediate treatment, but recurrence of cysts is common. Placement of a Word catheter into the cyst cavity decreases the incidence of reocclusion. The catheter, however, must remain in place up to 6 weeks to ensure epithelialization.
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Antibiotics are usually not required after incision and drainage.
Incise the internal (medial) surface of the cyst or abscess rather than the external (lateral) aspect, as the incision site may become the new drainage tract.
Refer recurrent abscesses to gynecologist for definitive treatment, which may involve marsupialization of the gland.
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