Bartholin glands are located bilaterally at the posterior vaginal introitus and have ducts that drain into the vulvar vestibule at the 4 and 8 o'clock positions to provide secretions for vulvovaginal lubrication. In CMS forums they state at the 5 & 7 o’ clock psotion relative to the opening of the vagina
The Bartholin glands are not palpable unless ductal blockage occurs, resulting in mucoid fluid buildup and cyst formation. The resultant obstruction causes proximal duct distension, resulting in cyst formation.
Abscesses are commonly polymicrobial and organisms may come from both the skin and enteric flora. If a single organism is identified, it is usually Neisseria gonorrhoeae, but this is not as common as a polymicrobial source. Bartholin gland abscesses are treated with incision and drainage, often with placement of a catheter to promote complete evacuation, followed by antibiotic administration.
The Bartholin ducts may become obstructed either from accumulation of mucus or secondary to edema and trauma, though many cases are idiopathic.
Women with small Bartholin duct cysts are often asymptomatic and may be diagnosed incidentally on routine examination as a soft mobile non tender cystic mass.
In contrast, larger cysts cause increased tissue tension and friction, resulting in vaginal pressure and discomfort with sexual activity, walking, or sitting (all of which apply direct pressure on the vulva and cyst). On pelvic examination, a soft, mobile non tender cystic mass is palpated behind the posterior labium majus with possible extension into the vagina.
Asymptomatic cysts can be managed expectantly as most of the cysts drain spontaneously and resolve on their own.
symptomatic cysts require incision and drainage with possible word catheter placement.
Some women develop recurrent Bartholin cysts or abscesses and undergo a marsupialization procedure, which creates another point of drainage for the Bartholin gland.
With ongoing obstruction and inflammation, infection can develop, leading to a Bartholin gland abscess, marked by erythema and tenderness to palpation of the cyst. Abscesses are commonly polymicrobial and organisms may come from both the skin and enteric flora. If a single organism is identified, it is usually Neisseria gonorrhoeae, but this is not as common as a polymicrobial source. Abscesses and cysts that are three centimeters or greater in diameter are often treated with incision and drainage.
Bartholin gland abscess can develop from an infected cyst; however, patients have additional findings of localized erythema and induration and a tender, fluctuant mass (.
(Choice E) Epidermal inclusion cysts appear as raised, mobile, flesh-colored nodules sometimes associated with a central punctum.
Sitz baths are used to treat Bartholin gland cysts. Clinical findings of Bartholin gland cysts include a nontender, unilateral palpable mass in the posterior vaginal introitus that can occasionally cause dyspareunia. However, this patient reports a tender mass, making a Bartholin gland abscess more likely.