Gynecology Book

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Bartholin's Gland AbscessAka: Bartholin's Gland Duct Cyst, Bartholin's Gland Cyst, Bartholin's Gland, Bartholin's Abscess, Bartholin's Cyst, Word Catheter

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  1. Epidemiology
    1. Bartholin's Gland duct cysts and abscess Incidence: 2%
    2. Most common in adult women under age 30 years
  2. Pathophysiology
    1. Bartholin's Gland
      1. Vaginal vestibular glands provide moisture
      2. Located at bilateral inferior labia minora
      3. Drain via ducts at 4:00 and 8:00 positions of labia
      4. Normal Bartholin's gland size <1 cm
    2. Bartholin's Gland Duct Cyst
      1. Results from distal duct obstruction
    3. Bartholin's Gland Abscess (more common than cysts)
      1. May occur spontaneously or as infection of duct cyst
  3. Bacterial causes
    1. Neisseria gonorrhoeae
    2. Staphylococcus aureus
    3. Streptococcus faecalis
    4. Escherichia coli
    5. Pseudomonas aeruginosa
    6. Chlamydia trachomatis
    7. Bacteroides fragilis
    8. Clostridium perfringens
  4. Symptoms
    1. Vulvar Pain worse with walking and intercourse
  5. Signs
    1. Firm swelling at posterior vaginal introitus
      1. Posterior labia minora affected
  6. Differential Diagnosis
    1. Epidermal Inclusion Cyst (at labia majora)
    2. Skene's Duct cyst (at urethral meatus)
    3. Other benign growth (mucous cyst, fibroma, Lipoma)
    4. Squamous Cell Carcinoma (esp. postmenopausal woman)
  7. Management: Word Catheter Placement for cyst or abscess
    1. Betadine prep overlying abscess wall at labia
    2. Administer Local Anesthesia with Lidocaine 1%
    3. Make 5 mm stab incision over abscess with #11 blade
      1. Incision should be oriented vertically
      2. Incision should lie outside hymenal ring
    4. Insert word catheter into incision
      1. Inflate Word catheter balloon with 2-3 c saline
    5. Word catheter remains in place for 4-6 weeks
  8. Management: Other measures
    1. Marsupialization of Bartholin's Gland cysts
      1. Only use for cysts (contraindicated for abscess)
      2. Cyst wall excised
    2. Excision of of Bartholin's Gland abscess
      1. Indicated if refractory to other measures
      2. Procedure timed when no infection present
      3. Refer to Gynecology or Surgery for procedure
  9. References
    1. Apgar in Pfenninger (1994) Procedures p. 596-600
    2. Omole (2003) Am Fam Physician 68(1):135

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