What is Bartholin Gland?
It is a homologue of the male bulbourethral glands, which are found bilaterally at 4 and 8 o’clock of the lower part of the entrance vagina and drain through ducts from 2.0cm to 2.5 cm long. It is considered an accessory gland. The glands are not palpable (unable to feel by touch) and usually pea-sized, less than 1 cm. Bartholin glands secrete vaginal lubricating mucus during sexual arousal and sexual intercourse. Removal of a Bartholin gland does not affect lubrication with the presence of Skene’s gland which can produce lubricant.
About Bartholin Abscess
Rolls of Bartholin’s glands lie at the entrance to the vagina and secrete mucus. The passageway of ducts to these glands can become blocked, causing a lump swelling otherwise known as a cyst. When the cyst becomes infected, an abscess containing pus is formed. Abscesses are not always preceded by an infected cysts and they can occur 3 times more often as a cyst. Common causes for a cyst would include infections such as Escherichiacoli and Staphylococcusaureus. With oral sex however, we are noticing more Streptococcuspneumoniaeand Haemophilusinfluenzaecausing cysts as well.
Bartholin Gland Leading to Malignancy
Bartholin gland involution occurs by the age of 30 years old, and enlargement in women more than 40 years old should cause more suspicion for malignancy, particularly if the gland is firm, fixed, or irregularly shaped. Therefore, those above 40 years old are recommended to do a biopsy with or without excision to rule out malignancy. Early recognition of Bartholin’s cancer is important because of the risk of local invasion and metastasis, although cancers account for only about 5% of vulvar carcinomas. Squamous cell carcinoma and adenocarcinoma are the two most common types of Bartholin gland carcinomas. Human papillomavirus high risk type 16 is associated with the pathogenesis of squamous cell carcinoma.
How Were They Presented?
Presentation varies with the depth and size of the cyst or abscess. Mostly unilateral, medially protruding vulvar swelling may be accompanied by vulvar pain, dyspareunia or discomfort pain with walking or sitting. Fever may also be associated in patients with an abscess.
How to Overcome This?
The management depends on the cyst’s size, clinical features, patient’s age,and history of recurrence. A cysts without symptoms in women younger than 40 years old can be left untreated, while for larger cysts and abscesses may require minor surgical procedures and excisions. It Is necessary for antibiotic treatment of Bartholin duct cysts and simple gland abscesses with presence of sexually transmitted infection, urinary tract infection, or cellulitis. There are two most common procedures for Bartholin duct cysts and gland abscesses which is fistulization and marsupialization.
How About Recurrence?
Excision procedure is preferred after any recurrence. For the first recurrence, Word catheter fistulization and marsupialization can be used. Otherwise, the patient will be referred to a gynecologist for excision if has recurrent lesions, the cysts is larger than 5 cm, or the age is more than 40 years.
What Are The Procedures That Are Not Recommended?
Incision and drainage and needle aspiration (they have higher recurrence rates)