Bartholin gland Abscess

Introduction: Bartholin glands are locate on either side of the lower third of the vaginal introitus near the labia minora.
A cyst or abscess may result from an obstructed duct, often secondary to trauma or inflammation. Infection of the cyst is usually with mixed vaginal or fecal flora (Escherichia coli) but may also contain N gonorrhoeae and Chlamydia trachomatis.

Clinical Features: Cysts or abscesses may be asymptomatic or may lead to increasing pain, swelling,
an dyspareunia. A tender, fluctuant cystic mass with surrounding labial edema is easily appreciate on examination.

Differential diagnosis: Differentials should include

• epidermal inclusion cysts and sebaceous cysts of the labia majora, 
• hidradenitis suppurativa, 
• vulvar hematomas, 
• leiomyomas, 
• lipomas, and 
• fibromas.

Management: Simple incision and drainage followed by sitz baths is the most effective immediate treatment, but recurrence of cysts is common with this method . Placement of a Wordcatheter into the cyst cavity decreases the incidence of reocclusion. The catheter, however, must remain in place up to 6 weeks to ensure epithelialization.

Clinical Pearls:

1. Antibiotics are usually not require .

2. 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.

3. Refer recurrent abscesses to gynecologist for definitive treatment which may involve marsupialization of the gland .