Bartholin Gland Abscess
An extremely painful, infected cyst of the mucus-secreting Bartholin gland near the vaginal opening.
Emergency Management: Sepsis or suspected necrotizing fasciitis requires immediate surgical debridement and broad-spectrum IV antibiotics (e.g., Vancomycin + Piperacillin-Tazobactam).
A Bartholin gland abscess is an infection of the Bartholin gland, located at the posterior aspect of the vaginal introitus, usually arising from an obstructed Bartholin cyst. It results in a painful, fluctuant mass.
Detailed Overview
The Bartholin glands secrete mucus to lubricate the vagina. When a duct becomes obstructed, a cyst forms. If the cyst becomes infected, typically by polymicrobial vaginal flora or sexually transmitted pathogens, an abscess develops. It is a common cause of vulvar pain in reproductive-age women.
Epidemiology & Demographics
Affects approximately 2% of women during their reproductive years, most commonly between ages 20-30. Rare post-menopause.
Etiological Mechanism
Polymicrobial infection. Common pathogens include E. coli, Bacteroides, and Neisseria gonorrhoeae, Chlamydia trachomatis, and Staphylococcus aureus (including MRSA).
Primary Causes
Obstruction of the Bartholin duct followed by bacterial colonization and infection.
Obstruction of the main duct of the Bartholin gland prevents drainage of glandular secretions, causing cystic dilation. Bacteria, either endogenous vaginal flora or exogenous pathogens, seed the cyst, leading to localized inflammation, purulent exudate formation, and abscess expansion.
Diagnostic Criteria & Guidelines
Clinical diagnosis based on the presence of a painful, fluctuant, erythematous mass at the 4 or 8 oclock position of the vaginal introitus.
Incision and drainage (I&D) with placement of a Word catheter for 4 weeks. Trimethoprim-sulfamethoxazole (160/800 mg PO BID for 7 days) if high risk for MRSA or cellulitis is present.
Second-Line & Adjunctive Therapy
Marsupialization (surgical creation of a new permanent pouch/opening) if Word catheter fails or for recurrent abscesses.
Surgical & Procedural Management
I&D with Word catheter placement. Marsupialization for recurrences. Excision of the gland is reserved for postmenopausal women to rule out adenocarcinoma, or for multiple recurrences.
Patient Counseling & Advice
Explain that the Word catheter must remain in place for up to 4 weeks to allow a permanent drainage tract to form (epithelialization). Abstain from intercourse while the catheter is in place.
Follow-Up & Monitoring Schedule
Follow up in 2-3 days to check the catheter and evaluate resolution of cellulitis. Catheter removal after 4 weeks.
Preventive Strategies
Safe sex practices to prevent STIs. Good perineal hygiene.
Excellent with appropriate drainage. Recurrence is common (10-20%) if a permanent tract is not successfully formed.