Vulvar D/O

Question 1

Where are the Bartholin Glands?

Should you be able to palpate them?

Answer 1

4 o’clock and 8 o’clock locations on the periphery of the vagina

If normal, no

Question 2

____ is a blocked Bartholin duct w/ an accumulation of mucus

Answer 2

Bartholin Gland Cyst

Question 3

___ is an obstructed Bartholin duct that becomes infected–> Women who are at higher risk of ____ are at higher risk of this.

Answer 3

Bartholin Gland Abscess

STIs

Question 4

What are some S/s of a Bartholin Gland Cyst?

Answer 4

Usually, asymptomatic! Probably a coincidental finding on exam
Larger cysts may cause discomfort

Question 5

What are some S/s of a Bartholin gland abscess?

Answer 5

• Acute pain, unable to walk, sit, nor have intercourse
• Fever
• Prior hx of Bartholin cyst or abscess
• Unilateral, warm, tender, soft or fluctuant mass in lower medial labia majora, can extend into upper labia
• Can be surrounded by erythema and edema
• Purulent spontaneous drainage possible

Question 6

What is the management for a Bartholin gland cyst?

Answer 6

No intervention if asymptomatic!

> 40 y/o—Incision and Drainage w/ bx to exclude malignancy

If symptomatic, manage same as abscess

Question 7

What is the management for a Bartholin gland abscess?

Answer 7

• Spontaneous drainage, analgesics, sitz baths
• Incision and Drainage w/ placement of a Word Catheter
• Culture/NAAT of purulent discharge (STI, MRSA)
• Incision and Drainage w/ marsupialization if recurrent

Definitive tx = gland excision
Abx = only for recurrent abscess, MRSA or STI positive, high risk of sepsis