Bartholin gland masses: Diagnosis and management
- Katherine T Chen, MD, MPH
Katherine T Chen, MD, MPH
- Professor of Obstetrics, Gynecology, and Reproductive Science
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
The Bartholin glands (also called the greater vestibular glands) are located in the vulva (figure 1), and blockage of the Bartholin ducts is a common etiology of a vulvar mass. The most common Bartholin masses are cysts or abscesses; Bartholin benign tumors and carcinomas are rare. Symptomatic Bartholin cysts and abscesses account for 2 percent of all gynecologic visits per year .
This topic will focus on cysts and abscesses, but will also provide brief information on Bartholin benign tumors and carcinomas. Vulvar abscess, vulvar lesions, and vulvar cancer are discussed in detail separately. (See "Vulvar abscess" and "Vulvar lesions: Differential diagnosis based on morphology" and "Vulvar cancer: Epidemiology, diagnosis, histopathology, and treatment of rare histologies".)
BARTHOLIN GLAND ANATOMY
The Bartholin glands (also called the greater vestibular glands (figure 2)) are the female homologue of the bulbourethral glands in the male. The Bartholin gland's main function is to secrete mucus to provide vaginal and vulvar lubrication .
Each Bartholin gland is approximately 0.5 cm in size and drains tiny drops of mucous into a duct 2.5 cm long. The glands are deep to the posterior aspects of the labia majora. The ducts open onto the vulvar vestibule at the four and eight o'clock positions on each side of the vaginal orifice, just below the hymenal ring (figure 1).
The Bartholin gland is composed of several epithelial types: The body is mucinous acini, the duct is predominantly transitional epithelium, and the orifice is squamous epithelium .
- Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis 2004; 8:195.
- Lee MY, Dalpiaz A, Schwamb R, et al. Clinical Pathology of Bartholin's Glands: A Review of the Literature. Curr Urol 2015; 8:22.
- Heller DS, Bean S. Lesions of the Bartholin gland: a review. J Low Genit Tract Dis 2014; 18:351.
- Berger MB, Betschart C, Khandwala N, et al. Incidental bartholin gland cysts identified on pelvic magnetic resonance imaging. Obstet Gynecol 2012; 120:798.
- Omole F, Simmons BJ, Hacker Y. Management of Bartholin's duct cyst and gland abscess. Am Fam Physician 2003; 68:135.
- Aghajanian A, Bernstein L, Grimes DA. Bartholin's duct abscess and cyst: a case-control study. South Med J 1994; 87:26.
- Yuk JS, Kim YJ, Hur JY, Shin JH. Incidence of Bartholin duct cysts and abscesses in the Republic of Korea. Int J Gynaecol Obstet 2013; 122:62.
- Brook I. Aerobic and anaerobic microbiology of Bartholin's abscess. Surg Gynecol Obstet 1989; 169:32.
- Tanaka K, Mikamo H, Ninomiya M, et al. Microbiology of Bartholin's gland abscess in Japan. J Clin Microbiol 2005; 43:4258.
- Kessous R, Aricha-Tamir B, Sheizaf B, et al. Clinical and microbiological characteristics of Bartholin gland abscesses. Obstet Gynecol 2013; 122:794.
- Lee YH, Rankin JS, Alpert S, et al. Microbiological investigation of Bartholin's gland abscesses and cysts. Am J Obstet Gynecol 1977; 129:150.
- Rees E. Gonococcal bartholinitis. Br J Vener Dis 1967; 43:150.
- Wren MW. Bacteriological findings in cultures of clinical material from Bartholin's abscess. J Clin Pathol 1977; 30:1025.
- Bleker OP, Smalbraak DJ, Schutte MF. Bartholin's abscess: the role of Chlamydia trachomatis. Genitourin Med 1990; 66:24.
- Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician 1998; 57:1611.
- Thurman AR, Satterfield TM, Soper DE. Methicillin-resistant Staphylococcus aureus as a common cause of vulvar abscesses. Obstet Gynecol 2008; 112:538.
- Sherer DM, Dalloul M, Salameh G, Abulafia O. Methicillin-resistant Staphylococcus aureus bacteremia and chorioamnionitis after recurrent marsupialization of a bartholin abscess. Obstet Gynecol 2009; 114:471.
- Laibl VR, Sheffield JS, Roberts S, et al. Clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus in pregnancy. Obstet Gynecol 2005; 106:461.
- Visco AG, Del Priore G. Postmenopausal bartholin gland enlargement: a hospital-based cancer risk assessment. Obstet Gynecol 1996; 87:286.
- Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv 2009; 64:395.
- Reif P, Ulrich D, Bjelic-Radisic V, et al. Management of Bartholin's cyst and abscess using the Word catheter: implementation, recurrence rates and costs. Eur J Obstet Gynecol Reprod Biol 2015; 190:81.
- Ozdegirmenci O, Kayikcioglu F, Haberal A. Prospective Randomized Study of Marsupialization versus Silver Nitrate Application in the Management of Bartholin Gland Cysts and Abscesses. J Minim Invasive Gynecol 2009; 16:149.
- Gennis P, Li SF, Provataris J, et al. Jacobi ring catheter treatment of Bartholin's abscesses. Am J Emerg Med 2005; 23:414.
- Word B. Office treatment of cyst and abscess of Bartholin's gland duct. South Med J 1968; 61:514.
- Haider Z, Condous G, Kirk E, et al. The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study. Aust N Z J Obstet Gynaecol 2007; 47:137.
- Mungan T, Uğur M, Yalçin H, et al. Treatment of Bartholin's cyst and abscess: excision versus silver nitrate insertion. Eur J Obstet Gynecol Reprod Biol 1995; 63:61.
- Fambrini M, Penna C, Pieralli A, et al. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol 2008; 15:327.
- de Góis Speck NM, Belfort PN, Mendes P, et al. Carbon dioxide laser treatment of Bartholin's gland cyst. Clin Exp Obstet Gynecol 2007; 34:50.
- Lashgari M, Keene M. Excision of Bartholin duct cysts using the CO2 laser. Obstet Gynecol 1986; 67:735.
- Benedetti Panici P, Manci N, Bellati F, et al. CO2 laser therapy of the Bartholin's gland cyst: surgical data and functional short- and long-term results. J Minim Invasive Gynecol 2007; 14:348.
- Davis GD. Management of Bartholin duct cysts with the carbon dioxide laser. Obstet Gynecol 1985; 65:279.
- Rajendran PM, Young D, Maurer T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007; 51:4044.
- Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med 1985; 14:15.
- Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373.
- Kohagura K, Sesoko S, Tozawa M, et al. [A female case of Fournier's gangrene in a patient with lupus nephritis]. Nihon Jinzo Gakkai Shi 1998; 40:354.
- Lopez-Zeno JA, Ross E, O'Grady JP. Septic shock complicating drainage of a Bartholin gland abscess. Obstet Gynecol 1990; 76:915.
- DePasquale SE, McGuinness TB, Mangan CE, et al. Adenoid cystic carcinoma of Bartholin's gland: a review of the literature and report of a patient. Gynecol Oncol 1996; 61:122.
- Alsan CI, Vinh-Hung V, Eren F, Abacioğlu U. Adenoid cystic carcinoma of the Bartholin's gland: case report and systematic review of the literature. Eur J Gynaecol Oncol 2011; 32:567.
- Kozakiewicz B, Dmoch-Gajzlerska E, Roszkowska-Purska K. Carcinomas and sarcomas of Bartholin gland. A report of nine cases and review of the literature. Eur J Gynaecol Oncol 2014; 35:243.
- Copeland LJ, Sneige N, Gershenson DM, et al. Bartholin gland carcinoma. Obstet Gynecol 1986; 67:794.
- BARTHOLIN GLAND ANATOMY
- TYPES OF BARTHOLIN GLAND MASSES
- Epidemiology and risk factors
- Bartholin cyst
- Bartholin abscess
- - Microbiology
- Bartholin benign tumor
- Bartholin gland carcinoma
- CLINICAL PRESENTATION
- Physical examination
- Abscess cultures
- DIFFERENTIAL DIAGNOSIS
- - Overview
- - Incision and drainage
- Choosing a procedure
- Incision and drainage
- Word catheter
- Other procedures
- - Gland excision
- - Role of antibiotics
- Antibiotic regimens
- - Recurrent abscess
- SPECIAL CLINICAL CONSIDERATIONS
- Pregnant women
- Immunocompromised women
- BARTHOLIN GLAND CARCINOMA
- Clinical manifestations
- Evaluation and diagnosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS