Epidemiology & Risk Factors

Obstruction of distal main duct of Bartholin gland (located at 4 and 8 o’clock positions of posterior introitus).
Peaks in reproductive-aged women (20–29 yo).
Pathogens in abscess: Polymicrobial skin/enteric flora (E. coli, S. aureus) + STIs (N. gonorrhoeae, C. trachomatis).

Clinical Features

Bartholin Cyst:
- Asymptomatic or mild pelvic pressure/discomfort.
- Painless, soft, non-tender mass at posterior labium majus / introitus.
Bartholin Abscess:
- Severe, acute pain (dyspareunia, severe pain with walking/sitting).
- Erythematous, fluctuant, highly tender mass w/ surrounding induration and edema.
- Fever, chills, and purulent discharge if spontaneous rupture occurs.
Red Flag: Any labial/Bartholin mass in patients >40 years old (R/O Bartholin gland carcinoma).

Initial / Clinical: Visual inspection and palpation (fluctuant, tender posterior introitus mass).
Key Labs:
- Gram stain & culture of purulent exudate (if drained/ruptured).
- NAAT for N. gonorrhoeae & C. trachomatis.
Confirmatory / Biopsy: Indicated for patients >40 years old, postmenopausal patients, persistent/recurrent non-healing lesions, or mass with solid/nodular features to R/O adenocarcinoma/SCC.

Gartner Duct Cyst: Diff by location along anterolateral vaginal wall (remnant of mesonephric/Wolffian duct).
Nabothian Cyst: Diff by benign location directly on the cervix (mucus retention cyst).
Skene Gland Abscess/Cyst: Diff by periurethral location at 1 and 11 o’clock adjacent to external urethral meatus.
Epidermoid Cyst: Diff by subcutaneous location anywhere on vulva, presence of a central punctum, slow-growing.
Bartholin Gland Carcinoma: Diff by hard, fixed, non-fluctuant mass in postmenopausal women; confirmed via biopsy.

Asymptomatic Cyst (Premenopausal):
- Expectant management / warm sitz baths. No intervention required.
Symptomatic Cyst or Abscess:
1. Incision & Drainage (I&D) with Word Catheter Placement: First-line. Catheter inflated w/ 2–3 mL saline and left in place for 4–6 weeks to permit re-epithelialization of drainage tract.
2. Marsupialization: Surgical creation of a permanent open pouch. Reserved for recurrent cysts/abscesses or after Word catheter failure.
Antibiotic Therapy:
- NOT routinely indicated for simple, uncomplicated I&D.
- Indications for Abx: Recurrent infection, systemic signs (fever, tachycardia), high risk (pregnancy, immunocompromised, DM2), extensive surrounding cellulitis, or positive N. gonorrhoeae / C. trachomatis / MRSA culture.
- Empiric Regimen: Vancomycin or TMP-SMX (for MRSA) + Ceftriaxone/Doxycycline (if STI suspected).
Patients >40 Years Old:
- Biopsy of cyst wall ± complete surgical excision.

Recurrence (most common).
Vulvar cellulitis or necrotizing fasciitis (rare, in immunocompromised/diabetic pts).
Chronic fistula or sinus tract formation.

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