BARTHOLIN’S CYST/ABSCESS17 January 2022
A cyst is an abnormal sac-like growth containing fluid or other substance, when this sac-like growth contains pus, it is called an abscess. A cyst/abscess that forms in the Bartholin’s gland is called the Bartholin’s cyst/abscess. The Bartholin’s glands also called the greater vestibular glands in the female corresponds to the bulbourethral glands in the male also called the cowper’s glands. The Cowper’s glands are located beneath the prostate gland; their secretions are release into the urethral prior to ejaculation known as the pre-ejaculatory fluid (‘precum’). The Bartholin’s gland’s main function is to secrete mucus to provide vaginal and vulva lubrication during sexual intercourse.
Each Bartholin’s gland is approximately 0.5 cm in size and drains tiny drops of mucus into a duct about 2.5 cm long. The glands are deep to the posterior aspects of the labia majora. The ducts open onto the vulva vestibule at the four and eight o’clock positions on each side of the vaginal opening, just below the hymenal ring. Bartholin’s cyst or abscess occurs in about 3 in 100 women, most commonly between the ages of 20 and 30 years. When this occurs in a woman who has reached menopause, this may be a cancer although, the incidence is < 1 in 100.
CAUSES OF BARTHOLIN’S CYST/ABSCESS
If the duct of a Bartholin’s gland becomes blocked either by infection, trauma, change in the consistency of the mucus or from a narrow duct which one might be born with. The mucus is unable to escape and therefore, a cyst will form. If this becomes infected, abscess formation occurs. The most common organisms causing this are Staphylococcus and Escherichia coli (E.Coli) although, other organisms may be encountered including Neisseria gonorrhoeae or Chlamydia.
Bartholin’s abscess is the end result of acute inflammation of the Bartholin’s gland. The duct gets blocked by fibrosis and the secretion builds up inside to produce abscess. If left uncared for, the abscess may burst through the lower vaginal wall. An abnormal passage called sinus tract may form which may remain open with periodic discharge through it.
SYMPTOMS AND SIGNS OF BARTHOLIN’S CYST/ABSCESS
Bartholin’s cysts are usually asymptomatic except for minor discomfort during sexual intercourse. Larger or infected cyst or abscess may present with such severe pain and swelling that the woman may find it difficult or impossible to walk, sit, or have sexual intercourse. The cysts are unilateral, round or ovoid, fluctuant or tense. If infected or with abscess formation; there is fever, tenderness, swelling beneath the posterior half of the labia majora expanding medially to the posterior part of the labia minora, the overlying skin appears red and oedematous.
TEST FOR BARTHOLIN’S CYST/ABSCESS
A couple of laboratory test are usually done; Culturing the cyst/abscess wall obtained during surgery will assist with the isolation of the infective organism, a complete blood count will indicate the presence of a bacterial infection, while a histology test of an excised gland will help rule out the possibility of a cancer. A substantial percentage of women with Bartholin’s gland abscess will be culture-positive for E. coli being the single most common pathogen, while others will show multiple bacteria as the infectious pathogens. Culture-positive cases will significantly be associated with fever and elevated white cell on complete blood count test. Infection with E. coli is significantly more common in recurrent infections than in primary infections.
TREATMENT OF BARTHOLIN’S CYST/ABSCESS
Small Bartholin’s cysts may require no treatment unless troublesome or to exclude cancer in women older than 40years, but abscess almost always do. An abscess is usually drained at the earliest opportunity before it bursts spontaneously. Antibiotics for empiric treatment of sexually transmitted diseases are advisable in the doses usually used to treat gonococcal and chlamydial infections. The treatment for Bartholin’s gland abscess is surgical, antibiotics may be started immediately prior to the surgical procedures. There are a number of surgical options and they include; incision and treatment with silver nitrate, marsupialization (which involves wide excision, drainage and eversion of the cyst wall to the vaginal skin), fistulization (incision, drainage and insertion of a catheter for 2–4 weeks), carbon dioxide laser incision and drainage, and needle aspiration of the cyst. Simple needle aspiration or incision and drainage may provide only temporary relief; as recurrent cystic dilatation may recur.
WHAT TO EXPECT AFTER SURGERY FOR BARTHOLIN’S ABSCESS?
After the procedure which is usually a day case; not requiring prior hospital admission. Your doctor will discharge you after you have fully recovered from anaesthesia. Oral antibiotics may be prescribed, analgesics will be given and you will be asked to do a Sitz bath as part of your treatment regimen. Clinic appointments will be schedule to review culture or histology result and to check the progress of wound healing. Complete healing should be anticipated by the end of the sixth week. Sexual intercourse can commence as soon as the wound is completely healed and you are no longer feel pain or discomfort.
COMPLICATION OF BARTHOLIN’S CYST/ABSCESS
The most common complication of treatment of Bartholin abscess is recurrence. Rare case reports exist of necrotizing fasciitis (flesh-eating disease; which occurs when bacteria enter and destroy tissues beneath the skin) after abscess drainage. Non healing wounds may occur. Bleeding especially in individuals with coagulopathy (impairment in clot formation) may be a complication and cosmetic scarring may result.