The two Bartholin glands secrete mucus to provide moisture for the vulva; they are the homologue of the bulbourethral glands in the male. These glands are located bilaterally in the vulvovaginal area at approximately the four and eight o'clock positions on the posterolateral aspect of the vaginal orifice. Each gland is approximately 0.5 cm in size and drains into a narrow duct 2.5 cm long. The ducts emerge onto the vestibule, one at each side of the vaginal orifice, just below the hymnal ring (figure 1).
Perineal inflammation or trauma can obstruct the orifice of a Bartholin gland duct, thereby leading to cystic dilation of the duct proximal to the obstruction. Intervention is usually not necessary because most cases are asymptomatic. However, some Bartholin cysts are disfiguring, cause discomfort, or become infected (Bartholin abscesses) and require treatment. (See "Disorders of Bartholin gland".) General principles of vulvar abscesses are discussed in detail separately (see "Vulvar abscess").
Cysts — Bartholin cysts average from 1 to 3 cm in size and are usually asymptomatic. Larger cysts may be associated with vulvar pain, discomfort during intercourse, or difficulty sitting or ambulating. Cysts are diagnosed upon finding a soft, painless mass in the labia or lower vestibular area by a routine pelvic examination or by the woman, herself.
Abscesses — A Bartholin abscess appears as a large, tender, soft or fluctuant mass in the labia or lower vestibular area, occasionally with erythema, edema, and pointing. Women usually present with such severe pain and swelling that they are unable to walk, sit, or have intercourse.
Differential diagnosis — Differential diagnosis of vulvovaginal masses is shown in the table (table 1).