Bartholin’s Gland Cyst/Abscess

26 Oct

Common in women of reproductive age, perimenopausal women should have cancer ruled out.

Pea size glands at the 4 and 8 O’Clock position, not normally palpable.

The purpose of the glands are to provide moisture for the vulva.

Duct obstruction causes cyst and abscess formation.

Usually a 2-4cm fluctuant mass on the labia.

 

Treatment includes I&D (gown/glove/mask recommended, for your own protection), catheter placement, and marsupialization.

  • For catheter, an elliptical incision is made along the vaginal mucosa with expression of pus.
  • Insert a Word catheter deep into the cavity, inflate the catheter balloon with saline.
  • If a Word catheter is not available, gauze can be used to pack the cavity.

 

Antibiotics, if indicated (controversial, as with many abscess/antibiotic discussions):

  • typically Keflex and/or Flagyl for polymicrobial vaginal flora
  • ceftriaxone/azithromycin for possible Neisseria/Chlamydia.

 

See OB in 2-7 days depending on severity.

 

Submitted by C. Stokes.

References: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition; Rosen’s Emergency Medicine. (2010); picture above; a less ‘safe for work’ photo illustration

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