In one study, Word catheter treatment was successful in 26 of 30 cases (87%) of Bartholin cyst or abscess. Patients with an abscess often feel. Read about the different ways of treating a Bartholin’s cyst, including soaking it in warm water, incision and drainage, or surgically removing the Bartholin’s. J Prat Rev Gen Clin Ther. Jun 8;64(23) [Treatment of bartholinitis]. [ Article in Undetermined Language]. REYMOND JC. PMID: ; [Indexed.
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Bartholin’s duct cysts and gland abscesses are common problems in women of reproductive age. Bartholin’s glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the yreatment o’clock and 8 o’clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops.
The differential diagnosis includes cystic and solid lesions of the vulva, such as epidermal inclusion cyst, Skene’s duct cyst, hidradenoma papilliferum, and lipoma.
The goal of management is to preserve the gland and its function if possible. Office-based procedures include insertion of a Word catheter for a duct cyst or gland abscess, and marsupialization of a cyst; marsupialization should not be used to treat a gland abscess.
Broad-spectrum antibiotic therapy is warranted only when cellulitis is present. Excisional biopsy is reserved for use in ruling out adenocarcinoma in menopausal or perimenopausal women with an irregular, nodular Bartholin’s gland mass. Family physicians can expect to encounter Bartholin’s duct cysts or gland treatmentt in their female patients.
These common problems often can be resolved with the use of simple office-based procedures such as Word catheter placement for duct cysts or gland abscesses, and marsupialization for duct cysts. Bartholin’s glands greater bartohlinitis glands are homologues of the Cowper’s glands bul-bourethral glands in males.
The Treat,ent glands develop from buds in the epithelium of the posterior area of the vestibule. The glands are located bilaterally at the base of the labia minora and drain through 2- to 2.
The glands are usually the size of a pea and rarely exceed 1 cm. They are not palpable except in the presence of disease or infection. Bartholin’s duct cysts, the most common cystic growths in the vulva, 45 occur in the labia majora.
One case-control study 7 found that white and black women were more likely to develop Bartholin’s cysts or abscesses than Hispanic women, and that women of high parity were at lowest risk.
Gradual involution of the Bartholin’s glands can occur by the baetholinitis a woman reaches 30 years of age. Because a vulvar mass in a postmenopausal woman can be cancer, excisional biopsy may be required. Some investigators 9 have suggested that surgical excision is unnecessary bartholiniitis of the low risk of Bartholin’s gland cancer 0.
However, if the diagnosis of cancer is delayed, the prognosis can be poor.
treeatment Obstruction of the distal Bartholin’s duct may result in the retention of secretions, with resultant dilation of the duct and formation of a cyst. The cyst may become infected, and an abscess may develop in the gland.
A Bartholin’s duct cyst does not necessarily have to be present before a gland abscess develops. Bartholin’s gland abscesses are polymicrobial Table 1. Information from references 411and If a Bartholin’s duct cyst remains small and does not become inflamed, it may be asymptomatic. However, the cyst typically presents as a medially protruding mass in the posterior introitus in the region where the duct opens into the vestibule.
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For the missing bartholiniris, see the original print version of this publication. Bartholin’s duct cysts and gland abscesses must be differentiated from other vulvar masses. Because the Bartholin’s glands usually shrink during menopause, a vulvar growth in a postmenopausal woman should be evaluated for malignancy, especially if the mass is irregular, nodular, and persistently indurated. Benign, mobile, nontender; caused by trauma or obstruction of pilosebaceous ducts.
Soft, less than 2 cm in diameter, smooth surface, superficial location; solitary or multiple; usually asymptomatic. Benign, slow-growing, small nodule 2 mm to bartholiniris cm ; arises from apocrine sweat glands. Soft, compressible; peritoneum entrapped within round ligament; may mimic inguinal hernia.
Benign, asymptomatic; if large, may cause urethral obstruction and urinary retention. Firm, asymptomatic; may develop pedicle; may barthllinitis myxomatous degeneration; potential for malignancy. Benign, fleshy, variable size; usually pedunculated but may be sessile; polypoid in appearance.
Small, fleshy; polypoid in appearance; multiple; associated with von Recklinghausen’s disease. Rare, benign; vascular; variable size and shape; single or multiple; associated with and aggravated by pregnancy; associated with Fabry’s disease.
Related to benign epithelial disease in older women and to human papillomavirus infection in young women. The treatment of a Bartholin’s duct cyst depends trwatment the patient’s symptoms. An asymptomatic cyst may require no treatment, 2 but symptomatic Bartholin’s duct cysts and gland abscesses require drainage.
Unless spontaneous rupture occurs, an abscess rarely resolves traetment its own. Although incision and drainage is a relatively quick and easy procedure that bartholunitis almost immediate relief to the patient, this approach should be discouraged because there is a tendency for the cyst treatmemt abscess to recur.
Furthermore, incision and drainage may make later Word catheter placement or marsupialization difficult. Definitive drainage involves Word catheter placement for Bartholin’s duct cysts and gland abscesses, and marsupialization for duct cysts.
A Word catheter is commonly used to treat Bartholin’s duct cysts and gland abscesses. The small, inflatable balloon tip of the Word catheter can hold about 3 mL of saline Figure 3.
After sterile preparation and the administration of a local anesthetic, the wall of the cyst or abscess is grasped with a small forceps, and a no. It is important to grasp the cyst wall before the incision is made; rteatment the cyst can collapse, and a false tract may be created. After the incision is made, the Word catheter is inserted, and the balloon tip is inflated with 2 to 3 mL of saline solution injected through the hub of the catheter.
The inflated balloon allows teatment catheter to remain within bartholiniis cavity of the cyst or abscess Figure 3. The free end of the catheter can be placed in the vagina. Sitz baths taken two to three times daily may aid patient comfort and healing during the immediate postoperative period.
Coitus may be resumed after catheter insertion. Unless there is evidence of cellulitis, antibiotic therapy is unnecessary. If cellulitis is present, cultures may be obtained, but the results rarely bartholniitis management.
Empiric broad-spectrum antibiotic therapy is started before culture results are available. If a Bartholin’s cyst or abscess is too deep, Word catheter placement is impractical, and other options must be considered. An alternative to Word catheter placement is marsupialization of a Bartholin’s cyst Figure 4. This procedure should not be used when an abscess is present.
Bartholinltis of Bartholin’s duct cyst. Left A vertical incision is made over the center of the cyst to dissect it free of mucosa.
[On the treatment of bartholinitis and cysts of Bartholin’s gland].
Right The cyst wall bartholinittis everted and approximated to the edge of the vestibular mucosa with interrupted sutures. A vertical incision is made in the vestibule over the center of the cyst and outside the hymenal ring. After the cyst is vertically excised, the cavity drains spontaneously. The cavity also may be irrigated with saline solution and, if necessary, loculations can be broken up with a hemostat. The cyst wall is then everted and approximated to the edge of the vestibular mucosa with interrupted absorbable suture.
Bartholin’s cyst – Treatment – NHS
Approximately 5 to 15 percent of Bartholin’s duct cysts recur after marsupialization. Although Bartholin’s gland abscesses may rupture and drain spontaneously, recurrence is likely, and surgical excision may be necessary.
Excision is not an office-based procedure. However, Bartholin’s gland abscesses tend to be polymicrobial, and empiric broad-spectrum antibiotic therapy should be used. Excision of the Bartholin’s gland should be considered in patients who do not respond to conservative attempts to create a drainage tract, but the procedure should be performed when there is no active infection. Some investigators 210 recommend excision of the Bartholin’s gland to exclude adenocarcinoma when cysts or abscesses occur in patients more than 40 years of age.
Even though adenocarcinoma of the Bartholin’s gland is rare, gynecologic oncology referral should be considered for older patients with Bartholin’s duct cysts or gland abscesses. Already a member or subscriber? Omole completed a family medicine residency at Morehouse School of Medicine. Hacker graduated from the University of the West Indies, Jamaica, and completed a family medicine residency at Morehouse School of Medicine.
Address teeatment to Folashade Omole, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts bartholinltis interest. The authors thank Barbara S.
Bartholin’s cyst – Diagnosis and treatment – Mayo Clinic
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Aerobic and anaerobic microbiology of Bartholin’s abscess. The role of Chlamydia trachomatis in Bartholin’s gland abscess. Bartholinitis after vulvovaginal surgery. Procedures for primary care physicians.