Bartholin gland Flashcards
Describe the anatomical location and structure of the Bartholin glands
Located in vulva deep to the posterior aspect of the labia minora.
Each gland 0.5 cm in size and drains mucus into a 2.5 cm long duct which open onto the vulvar vestibule at 4 and 8 o’clock positions
Bartholin body: mucinous acini.
Duct: transitional epithelium.
Orifice: squamous epithelium.
What is the primary function of the Bartholin gland?
To secrete mucus to provide vaginal and vulvar lubrication.
What are the differential diagnoses for a Bartholin mass?
- Bartholin cyst
- Bartholin abscess
- Bartholin gland carcinoma
- benign Bartholin tumour
Non-Bartholins:
- extension of perianal infection.
- Labial abscess
- Haematoma
What is a Bartholin cyst?
When the orifice of the Bartholin duct becomes obstructed, accumulation of mucous produced by the gland causes cystic dilation proximal to the obstruction but does not affect the gland itself.
Usually sterile.
Typically painless and may be asymptomatic, however larger cysts may cause discomfort during sexual intercourse, sitting or walking.
What is a Bartholin abscess?
Results from secondary infection of an obstructed Bartholin duct. Women typically present with severe pain, preventing them from walking, sitting or having sexual intercourse.
What bacteria are typically associated with a Bartholin abscess?
- E coli most common.
- Staph aureus
- GBS
- Gonorrhoea
- Chlamydia
What % of vulvar malignancies affect the Bartholin gland?
What type of malignancies are involved?
What is the age of peak incidence?
0.1 - 5%
Most are adenocarcinomas or squamous cell carcinomas.
Peak age in 60s.
How should a first or second occurrence of an uncomplicated Bartholin abscess be managed?
Word catheter
How should a recurrence of aa Bartholin cyst or abscess after one or two Word catheter placements be managed?
I&D and marsupialisation.
How does a Word catheter work?
What are its advantages and disadvantages?
A Word catheter is a balloon-tipped device that is inserted into the cyst/abscess cavity immediately after incision and drainage. The bulb of the catheter is then inflated and left in place for at least four weeks to promote formation of an epithelialised tract for drainage of glandular secretions
Advantages:
- avoids general anaesthesia
- recurrence rates are lower than with incision and drainage alone (3%)
Disadvantages:
- catheter may be irritating and may dislodge or fall out before the tract is epithelialised, which can increase the risk of recurrence.
What are the contraindications for a Word catheter?
What possible complications can occur?
Contraindications: latex allergy (needs I&D).
Complications: infection, bleeding and scarring causing dyspareunia, recurrence rate 2-15 percent.
What is marsupialisation?
What are its indications?
a new ductal orifice is created by incising the cyst/abscess and then everting and suturing the epithelium to the skin at the edge of the incision.
Indications: recurrent Bartholin’s abscess, when biopsy is required or when a procedure under local anaesthetic is not tolerated.
What are the advantages and disadvantages of marsupialisation?
What are the complications?
Advantages:
- Less postprocedure discomfort
Disadvantages:
- Needs GA
Complications: bleeding, infection, recurrence (5-20%), moderate pain, haematoma formation, prolonged healing and scarring causing dyspareunia
What is the indication for Bartholin gland excision?
What are the complications?
Definitive treatment for abscesses and cysts but is usually only performed after other less invasive treatments have repeatedly failed or for Bartholin carcinoma.
Complications: bleeding (higher than other procedures), haematoma, infection, scarring and disfigurement, dyspareunia. Rarely vaginal dryness and dyspareunia is a consequence
Regarding Bartholin abscesses:
When are antibiotics indicated?
o Recurrent Bartholin abscess
o High risk of complicated infection (sepsis) including: extensive surrounding cellulitis, pregnancy, immunocompromise, risk factors (recent hospitalization or residence in long-term care facility, recent surgery, haemodialysis, HIV infection, IV drug use, prior antibiotic use,).
o Culture-positive methicillin-resistant Staphylococcus aureus (MRSA).
o Signs of systemic infection (fever, chills)
