BARTHOLIN GLAND DUCT CYST

PATHOPHYSIOLOGY

• Mucus produced to moisten the vulva

originates in part from the Bartholin glands.
• Obstruction of this gland’s duct is common and
may follow infection, trauma, changes in mucus
consistency, or congenitally narrowed ducts.
• However, the underlying cause often is unclear.
 PATHOPHYSIOLOGY

• In some cases, cyst contents may

become infected and lead to abscess
formation.
• A wider spectrum of organisms
responsible for these cysts and
abscesses.
 PATHOPHYSIOLOGY

• Tanaka and colleagues (2005) examined

224 patients and isolated approximately
two bacterial species per case.
• A majority were caused by aerobic
bacteria, of which Escherichia coli was the
most common isolate. Only five cases
involved N gonorrhoeae or Chlamydia
trachomatis.
 CLINICAL FINDINGS

• Minor discomfort during sexual arousal

• With larger or infected cysts
 severe vulvar pain that precludes
walking,
sitting, or sexual activity
BARTHOLIN GLAND DUCT CYST

• Cysts typically are unilateral, round

or ovoid, and fluctuant or tense.
• If infected, they display surrounding
erythema and are tender.
• The mass is usually located in the
inferior labia majora or lower
vestibule.
• Most cysts and abscesses lead to
labial asymmetry
• Smaller cysts may only be detected
by palpation.
 TREATMENT

• Small, asymptomatic Bartholin gland duct

cysts require no intervention except
exclusion of neoplasia in women older than
40 years.
• A symptomatic cyst may be managed with
one of several techniques.
Incision and drainage (I&D)
marsupialization
Bartholin gland excision
 INCISION AND DRAINAGE

• Analgesia and Patient Positioning.

• Drainage.
• Word Catheter Placement.
MARSUPIALIZATION

1. Anesthesia and
Patient
Positioning.
2. Skin Incision.
3. Cyst Incision.
4. Wound Closure.
 POSTOPERATIVE

• Cool packs during the first 24 hours following surgery can

minimize pain, swelling, and hematoma formation.
• After this time, warm sitz baths, one or two times each day, are
suggested for pain relief and wound hygiene.
• Intercourse is postponed until after incision healing.
 POSTOPERATIVE

• Patients may be seen within the first week following surgery to

ensure that ostium edges have not adhered to each other
• Within 2 to 3 weeks, the wound shrinks to create a duct
opening typically 5 mm or less.
• Recurrence rates following marsupialization are low.
 CYSTECTOMY

• Symptomatic cysts, however, which repeatedly recur and refill

following I&D or marsupialization are typical candidates for excision.
• Moreover, massive cysts, multilocular cysts, or those with solid
components are best managed with excision.
• Bartholin gland duct abscesses are not suitable for excision and are
instead incised and drained.
CYSTECTOMY

1. Analgesia and Patient

Positioning.
2. Skin Incision.
3. Cyst Dissection.
4. Vessel Ligation.
5. Wound Closure.
THANK YOU