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. The glands are impalpable and usually pea-sized, rarely exceeding 1 cm. 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. Abscesses are not always preceded by cysts and occur three times more often.
Escherichia coli and Staphylococcus aureus are the most common isolates. Bartholin gland involution occurs by 30 years of age, and enlargement in women older than 40 years should raise suspicion for malignancy, particularly if the gland is firm, fixed, or irregularly shaped. Human papillomavirus, particularly type 16, is associated with the pathogenesis of squamous cell carcinoma of the Bartholin gland. Presentation varies with the size and depth of the cyst or abscess.
Unilateral, medially protruding vulvar swelling Figure 2 may be accompanied by dyspareunia, vulvar pain, or pain with walking or sitting. Fever may also be present in patients with an abscess. Of the several available office procedures, none has been proven superior in terms of healing time or recurrence rate. Although needle aspiration and incision and drainage are not complicated to perform and have shorter healing time, they confer a considerably higher risk of lesion recurrence.
Management is determined by the cyst size, symptoms, patient's age, and history of recurrence. Fistulization and marsupialization are the two most common procedures for Bartholin duct cysts and gland abscesses.
Patient and clinician satisfaction with the Jacobi ring is higher compared with the Word catheter. Marsupialization is appropriate for treatment of a primary or recurrent Bartholin duct cyst or gland abscess. It creates a new outflow tract after the cyst wall shrinks over time and reepithelializes. Although no recent studies have compared all types of fistulization with marsupialization, some have compared Word catheter fistulization with marsupialization, with conflicting results.
