Bartholin gland abscess

Background

• Ducts of the glands drain into posterior vestibule at 4 o'clock and 8 o'clock positions
• A cyst does not need to be present for an abscess to develop

Diagnosis

• Mass in posterior introitus near 4 o'clock or 8 o'clock position
  • May develop over days or longer time (if preceded by cyst)
• Systemic symptoms (e.g. fever/chills) are rarely present

DDX

1. Cysts of other glandular structures
2. Leiomyoma
3. Lipoma
4. Carcinoma
   1. Consider in older women who present w/ introital mass

Treatment

1. I&D
   1. Only perform once abscess is well-defined, walled-off structure
      1. Inject local anesthetic
      2. Stab incision is made on the mucosal surface
      3. Extend incision for several mm but not so many that the Word catheter will fall out
      4. Insert Word catheter and inflate balloon w/ 2-4mL of water
      5. Tuck end of catheter into the vagina
      6. Catheter should remain in place for 4-6wk to avoid recurrence
2. Abx
   1. Cefixime 400mg PO QD x7d + clindamycin 300mg PO QID x7d

Source

Tintinalli