The Bartholin glands are located in the deep posterior third of the labia majora bilaterally, with their ducts opening between the hymen and the labia minora. Inflammation of the Bartholin glands, caused by pathogens invading the gland, can manifest as Bartholinitis, Bartholin gland abscess, or Bartholin gland cyst. This condition primarily affects women of reproductive age and is less common in young girls and postmenopausal women.
Pathogens
The condition often involves polymicrobial infections. Common pathogens include Staphylococcus, Escherichia coli, Streptococcus, and Enterococcus. With the rising prevalence of sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhoeae have also become frequent causative agents.
The pathogens initially invade the duct of the Bartholin gland, resulting in Bartholin gland inflammation. If ductal opening becomes obstructed due to swelling or accumulation of exudates, secretions may build up and exacerbate the infection, leading to the formation of a Bartholin gland abscess. If the abscess resolves but the duct remains blocked, resulting in the replacement of pus with viscous secretions, or if ductal obstruction persists with an accumulation of secretions, a Bartholin gland cyst may form. Bartholin gland cysts can become secondarily infected, evolving into recurrent abscesses.
Clinical Manifestations
Bartholin gland inflammation typically presents with an acute onset and usually affects one side. Early symptoms include localized swelling, pain, and a burning sensation. Examination reveals redness, swelling, and significant tenderness on the affected side; occasionally, a small white spot can be observed at the gland’s ductal opening.
If the infection worsens, an abscess can form, enlarging rapidly to 3–6 cm in diameter. This can cause severe localized pain and difficulty walking. When the abscess matures, fluctuation may be palpable. In some cases, systemic symptoms such as fever may occur, along with varying degrees of inguinal lymphadenopathy. As pressure within the abscess increases, the overlying skin and mucosa may thin, potentially leading to spontaneous rupture of the abscess.
A large rupture may allow for adequate drainage, leading to resolution of the inflammation and recovery. However, small ruptures with inadequate drainage may result in persistent inflammation and recurrent episodes. Bartholin gland cysts are often unilateral but can occasionally be bilateral. Small cysts without acute infection typically cause no symptoms and are often detected incidentally during gynecological examinations. Larger cysts may cause a sensation of vulvar heaviness or discomfort during intercourse. Examination reveals localized swelling at the affected Bartholin gland site, and a painless, cystic mass can often be palpated in the posteroinferior region of the vulva. The mass is generally round, well-defined, and non-tender.
Treatment
Antimicrobial Therapy
During acute inflammation episodes, maintaining local cleanliness is important. Vaginal secretions from the ductal opening of the Bartholin gland may be collected for bacterial culture to identify the causative pathogen. Cephalosporins or fluoroquinolones are commonly used and are often combined with metronidazole. Additionally, traditional Chinese medicine sitz baths may be used as an adjunct.
Surgical Management
For Bartholin gland abscesses, early incision and drainage are necessary to alleviate pain and control inflammation. Incisions should be made at sites with significant fluctuation, and a drainage wick or strip is typically placed. Pus from the abscess can be submitted for bacterial culture. Bartholin gland cysts that are asymptomatic can be monitored through follow-up. For larger or recurrent cysts, marsupialization may be performed.