Bartholin Duct Cyst and Gland Abscess: Office Management

 

Am Fam Physician. 2019 Jun 15;99(12):760-766.

  Patient information: A handout on this topic is available at https://familydoctor.org/condition/bartholins-gland-cyst.

Author disclosure: No relevant financial affiliations.

The Bartholin glands, located in the base of the labia minora, have a role in vaginal lubrication. Because of the presence of other glands, removal of a Bartholin gland does not affect lubrication. Ductal blockage of these typically pea-sized structures can result in enlargement of the gland and subsequent development of Bartholin duct cysts or gland abscesses. Two percent of women will develop a cyst or an abscess in their lifetime, and physicians should be familiar with the range of treatment options. Bartholin duct cysts and gland abscesses can be treated in the office. The healing and recurrence rates are similar among fistulization, marsupialization, and silver nitrate and alcohol sclerotherapy. Needle aspiration and incision and drainage, the two simplest procedures, are not recommended because of the relatively increased recurrence rate.

The Bartholin glands, homologues of the male bulbourethral glands, are found bilaterally at 4 and 8 o'clock of the labia minora and drain through ducts 2.0 to 2.5 cm long1,2 (Figure 11). The glands are impalpable and usually pea-sized, rarely exceeding 1 cm.2 The epithelium of the gland is columnar and the duct is squamous, allowing for the possibility of squamous cell carcinoma or adenocarcinoma development.3 During sexual arousal and intercourse, the Bartholin glands secrete vaginal lubricating mucus.2,4 Because of the presence of other glands, including the Skene glands, removal of a Bartholin gland does not affect lubrication.1,2,5

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Bartholin duct cysts or gland abscesses can be effectively treated by several office procedures under local anesthesia.

A

1, 2, 17, 19, 21, 32

Based on consistent evidence from patient-oriented studies and supported by usual practice

Biopsy with and without excision is recommended in patients 40 years and older to rule out malignancy.

C

1, 5, 8

Consensus based on expert opinion and supported by usual practice

Jacobi ring and Word catheter placement have acceptable recurrence rates and low complication risks.

B

19, 23

Based on consistent evidence from patient-oriented studies

Bartholin duct cysts or gland abscesses treated with incision and drainage alone or with needle aspiration have a high rate of recurrence.

B

1, 2, 5, 8, 17, 18

Based on patient-oriented evidence with small sample size


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferencesComments

Bartholin duct cysts or gland abscesses can be effectively treated by several office procedures under local anesthesia.

A

1, 2, 17, 19, 21, 32

Based on consistent evidence from patient-oriented studies and supported by usual practice

Biopsy with and without excision is recommended in patients 40 years and older to rule out malignancy.

C

1, 5, 8

Consensus based on expert opinion and supported by usual practice

Jacobi ring and Word catheter placement have acceptable recurrence rates and low complication risks.

B

19, 23

Based on consistent evidence from patient-oriented studies

Bartholin duct cysts or gland abscesses treated with incision and drainage alone or with needle aspiration have a high rate of recurrence.

B

1, 2, 5, 8, 17, 18

Based on patient-oriented evidence with small sample size


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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FIGURE 1.

Anatomy of Bartholin glands.

Illustration by Marcia Hartsock

Reprinted with permission from Omole F, Simmons BJ, Hacker Y. Management of Bartholin's duct cyst and gland abscess. Am Fam Physician. 2003;68(1):135.


FIGURE 1.

Anatomy of Bartholin glands.

Illustration by Marcia Hartsock

Reprinted with permission from Omole F, Simmons BJ, Hacker Y. Management of Bartholin's duct cyst and gland abscess. Am Fam Physician. 2003;68(1):135.

Pathology

Two percent of women develop a Bartholin duct cyst or gland abscess in their lifetime, and physicians should be familiar with the anatomy and range of treatment options.1,3 The ducts leading from the Bartholin glands can become obstructed, resulting in formation of cysts and, when infected, abscesses in the gland.6 Bartholin duct cysts and gland abscesses are more likely to

The Authors

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FOLASHADE OMOLE, MD, FAAFP, is a professor and chair of the Department of Family Medicine at Morehouse School of Medicine, Atlanta, Ga....

RIBA C. KELSEY, MD, MSCR, FAAFP, is director of the Family Medicine Residency Program and an assistant professor in the Department of Family Medicine at Morehouse School of Medicine.

KIWITA PHILLIPS, MD, is associate program director and an assistant professor in the Department of Obstetrics and Gynecology at Morehouse School of Medicine.

KIRSTIE CUNNINGHAM, MD, FACOG, is director of maternal child health and an assistant professor at Morehouse School of Medicine.

Address correspondence to Folashade Omole, MD, FAAFP, Department of Family Medicine, Morehouse School of Medicine, 720 Westview Dr., Atlanta, GA 30310 (e-mail: fomole@msm.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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