Bartholin’s cyst & abscess

Notes

## Basic introduction

  • Bartholin’s glands are located bilaterally in the vulva (close to the vaginal orifice)
  • They secrete mucus that lubricates the vagina during copulation
  • Bartholin’s cyst (Bartholinitis) occurs when a Bartholin's gland is blocked by infection or mucus, and sometimes the cause is not known. The secretions are retained in a capsule-like Bartholin’s cyst. They may become inflamed and infected to form an abscess.
Symptoms
  • Most of them are asymptomatic
  • Labial swelling (labial edema)
  • Local pain (sometimes on sitting or walking)
  • Fever
  • Dyspareunia
  • Perineal discomfort
  • Purulent vaginal discharge
  • Painful inguinal lymphadenopathy
  • Fluctuant abscess lateral to and near the posterior fourchette
  • Erythema

## Statistics

  • Globally, at least 2% of women will get Bartholin’s cyst or abscess at any stage of their lives
  • The incidence of the disease increases with age until menopause and then declines with age
Diagnosis
  • Clinical review
Differential
  • Carcinoma of vulva
  • Endometriosis
  • Folliculitis
  • Genital warts
  • Gonorrhoea
  • Haematoma
  • Hernia
  • Hidradenitis
  • Lipomata (on the labia majora)
  • Sebaceous cyst
  • Syphilis
  • Vaginitis
  • Vestibular mucous cysts
Prevention
  • None is currently known
Reference

1. Lee MY, Dalpiaz A, Schwamb R, et al; Clinical Pathology of Bartholin's Glands: A Review of the Literature. Curr Urol. 2015 May;8(1):22-5.

2. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

3. Omole, Folashade; Simmons, Barbara J.; Hacker Yolanda (2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–40

4. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

Management
  • Caps Doxycycline 100mg BD x 1/52
  • Tabs Ibuprofen 500mg TID x 5/7
  • Resting
  • Hot wet compresses
  • Incise and drain the abscess after applying lignocaine 1% gel (local anesthesia)
  • After drainage, pack the wound with a gauze impregnated with liquid paraffin and leave it for 24hrs
  • Advise the patient to sit on Sitz bath until the wound is healed.
  • Marsupialization for treatment of cysts (not abscess)
  • In a case where the problem is persistent, remove the entire gland.
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