Marie Elena Botte Bartholin glands, also known as the greater vestibular or vulvovaginal glands, were first discovered by the French anatomist Joseph-Guichard du Verney in the late 17th century1; their physiology was described by the Danish anatomist Gaspard Bartholin in 1677.2 These paired glands, homologous to the male bulbourethral glands in structure, placement, and function, have narrow ducts about 2.5 cm (1 inch) long that open into the vestibule just distal to the hymenal ring at the 5-o’clock and 7-o’clock positions. The glands become active at puberty and continuously secrete mucus through their narrow ducts. This mucus lubricates the vulva, and the glands are generally not palpable unless a cyst or abscess develops. Bartholin gland cysts are usually noninfectious enlargements of the gland related to ductal obstruction, which can occur as a result of inflammation, mucus, or congenitally even narrower ducts. Bartholin gland abscesses, also called bartholinitis or Bartholin adenitis, are the result of acute infection followed by obstruction. Bartholin gland cysts occur most often during women’s reproductive years, and an individual woman’s lifetime risk of developing a Bartholin cyst or abscess is approximately about 2%.3 A Korean study4 found that the incidence increases until menopause and then declines. Another study designed to estimate the prevalence of Bartholin gland cysts in asymptomatic women serving as controls in research studies found that 3% of the participants had cysts of the gland that were visible on magnetic resonance imaging (MRI).5 Half of these were on the right, nearly 43% were on the left, and the remaining 7% were bilateral. The cysts ranged in size from 0.5 to 2.7 cm, and on average the cysts were 1.3 × 1.2 × 1.3 cm. Clinicians are likely to encounter cysts of this gland approximately once per 46 pelvic examinations.6 Cysts of the Bartholin gland are related to obstruction of the duct orifice. They are most commonly the result of trauma, parturition, or episiotomy and can be the result of inflammatory scarring, epithelial metaplasia, or inspissated secretions that accumulate. In the presence of an infectious process, inflammation of the gland’s acinus may lead to abscess. Most cases are self-limited but can be severely discomforting. Any opportunistic genital or genitourinary organism can be the cause of an acute inflammation, and infections can be the result of single organisms or polymicrobial in nature. Although it has long been generally held that most abscesses of the gland are caused by polymicrobial and sexually transmitted infections, one 6-year retrospective study found that Escherichia coli was the single most common (47%) pathogen identified on culture,3 and less than 8% of all cases were polymicrobial. Nevertheless, studies have also demonstrated the presence of Chlamydia trachomatis, Neisseria sicca, “usual genital flora,7” methicillin-resistant Staphylococcus aureus,7 and Brucella melitensis; Bacteroides species have been detected in cultures from abscess formations in human immunodeficiency virus (HIV) antibody–positive women. Capnophilic bacteria, gram-negative bacteria (Proteus organisms), Neisseria gonorrhoeae, and polymicrobial flora including gram-negative and gram-positive anaerobes have also been cultured. Anaerobic and facultative aerobic organisms have also been implicated in abscess formation. Bartholin gland cysts are often asymptomatic, are generally unilateral, and range in size from 1 to 3 cm ( Physical examination includes vital signs, visualization of the affected area, and assessment of accompanying inguinal node involvement. Patients usually exhibit a unilateral, erythematous, edematous mass located lateral to the vestibule that ranges from tender to extremely painful. The size may vary, and discharge is usually present. A speculum or bimanual examination may be too painful until the cyst or abscess has been treated. Culture of cystic contents and the cervix for sexually transmitted diseases is recommended to ensure adequate treatment of women and their sexual contacts. A complete blood count (CBC) can identify leukocytosis. Cysts or abscesses of the Bartholin gland represent the majority of cysts in the vulvar region and are the most common diseases of the gland. Although solid benign tumors, adenocarcinomas, high-grade squamous intraepithelial neoplasias, carcinomas,8 sarcomas,9 mixed tumors, leiomyomas, adenofibromas, mucinous cystadenomas, myxoid leiomyosarcomas,10 papillary tumors, mucocele-like changes, endometriosis,11 and malacoplakia all can originate in (or, in the case of endometriosis, infiltrate) the Bartholin gland, these presentations are rare. Carcinoma of the Bartholin gland, which can be primary, accounts for less than 1% of all genital neoplasms in female patients. Tuberculosis of the Bartholin gland is also rare (vulval and vaginal infections account for less than 2%of genital tuberculosis) but should be considered if swelling does not resolve after excision. Primary neuroendocrine carcinoma (Merkel cell carcinoma) of the vulva can both originate in Bartholin gland and mimic Bartholin gland abscess.
Bartholin Gland Cysts and Abscesses
Definition and Epidemiology
Pathophysiology
Clinical Presentation
to 
inches); they can be chronic or recurrent. Associated pain is usually a sign of an infectious process and development of an abscess, which can often grow large and rapidly during 2 to 4 days. Women may be seen with pain (especially while walking or standing), swelling, dyspareunia, or tenderness. Specific inquiry into recent history of an infectious process may yield clues to the cause. A recent vaginal delivery or history of localized trauma should be explored.
Physical Examination
Diagnostics
Differential Diagnosis
Bartholin Gland Cysts and Abscesses
Chapter 156
