AKT · Obstetrics & gynaecology/Menopause & vulvallow yield

Bartholin cyst & abscess

Bartholin duct obstruction ± infection

Overview

Obstruction of a Bartholin gland duct causes a cyst; secondary infection causes a painful abscess. A common cause of a unilateral, posterolateral vulval (introital) swelling.

Recognise

Unilateral, fluctuant swelling at the posterior introitus (4 or 8 o’clock)
Cyst: often painless; abscess: acutely painful, red, hot, with dyspareunia
Difficulty sitting/walking when large

Red flags

A vulval mass in a woman >40 → consider biopsy to exclude rare Bartholin gland carcinoma

Differentials & how to tell them apart

Vaginal/cervical cyst or tumourdifferent site; not at the gland position

Bartholin gland carcinomarare, older women, solid/irregular — biopsy

Vulval abscess/folliculitisnot at the duct orifice

Investigations

Clinical. Swab if an abscess (often polymicrobial; consider gonorrhoea/chlamydia). Biopsy if >40y/atypical to exclude carcinoma.

Management

Asymptomatic cyst: reassure; abscess: incision & drainage with marsupialisation (or Word catheter)

1Small asymptomatic cyst: conservative + warm baths. Abscess: incision and drainage with MARSUPIALISATION or a Word catheter.Gate: Simple incision & drainage alone tends to recur → marsupialisation/Word catheter reduces recurrence
2Vulval mass in a woman >40 → biopsy to exclude carcinoma; antibiotics if cellulitis/systemic features.

Analgesia ± antibiotics — antibiotics if surrounding cellulitis/sepsis or STI organisms

Key points

Marsupialisation or a Word catheter reduces recurrence versus simple drainage. Age >40 with a vulval mass = biopsy.

Monitor & prognosis

Recurrence; healing.

Good; recurrence reduced by marsupialisation.

Source: NICE CKS; gynaecology texts