Vulvar Concerns

Question 1

When should you biopsy or excise a Bartholin gland cyst to rule out adenocarcinoma?

Answer 1

Age > 40
Persistent mass or solid components
Recurrent infections

Question 2

Management of Bartholin cyst abscess

Answer 2

I&D + Word Catheter 4-6 weeks
Culture to rule out MRSA

If not successful could repeat word or do marsupialization and add antibiotics

Question 3

How do you place a Word Catheter?

Answer 3

Dorsal lithotomy
Clean the area
Inject local 1-3 ml
Incise the cyst with 11 blade scalpel
**5 mm stab incision, if incision too big, catheter will fall out
Make incision at the vaginal orifice or behind the hymen to prevent vulvar scarring

Drain cyst completely and break up loculations with hemostat
Send culture
Place Word catheter through incision as deep as possible
Place 2-3 ml of Saline or water into the catheter
Tuck end of word catheter into vagina to minimize discomfort

Keep catheter in until tract is re-epithelialized (usually at least 4 weeks). Recommend pelvic rest.

Question 4

Treatment of infected Bartholin gland cyst?

Answer 4

Bactrim DS 5-7 days (consider adding Augmentin or flagyl)

Question 5

Risk of developing squamous cell carcinoma with Lichen Sclerosus?

Answer 5

6% over 10 years