Women's Health: Bartholin Gland Cysts and Abscesses PDF

Women’s Health Chapter 138 BARTHOLIN GLAND CYSTS AND ABSCESSES  Definition Bartholin’s glands Become active at puberty and continuously secrete mucus through their narrow ducts that lubricates the vulva. The glands are generally not palpable unless a cyst/abscess develops Bartholin’s gland...

Women’s Health Chapter 138 BARTHOLIN GLAND CYSTS AND ABSCESSES  Definition Bartholin’s glands Become active at puberty and continuously secrete mucus through their narrow ducts that lubricates the vulva. The glands are generally not palpable unless a cyst/abscess develops Bartholin’s glands cysts Noninfectious enlargements of the gland related to ductal orfice obstruction. Occur during women’s reproductive years. ◦ Causes ◦ Inflammation ◦ Mucus ◦ Congenitally narrower ducts Bartholin’s gland abscesses/bartholinitis/Bartholin’s adenitis ◦ Causes ◦ Acute infection followed by obstruction Clinical Presentation Often asymptomatic or painful (sign of abscess) or tenderness on walking, dyspareunia Chronic or recurrent Generally unilateral Range in size from 1 to 3 cm (0.4 to 1.2 inches) Associated pain is usually a sign of an infectious process and development of an abscess (walking/standing with pain, swelling, dyspareunia, tenderness) Yield clues to cause by: specific inquiry into recent history of an infectious process, recent vaginal delivery, localized trauma history Physical Exam and Diagnostics Obtain vital signs. Visually inspect the affected area. Assess accompanying inguinal node involvement (unilateral and edematous mass lateral to the vestibule). Speculum or bimanual examination may be too painful until the cyst or abscess has been treated. Cysts- nontender Abscess- tender to extremely painful Diagnostics ◦ Culture of cystic contents and the cervix for STIs ◦ CBC for leukocytosis  Differential Diagnosis Solid benign tumors Adenocarcinomas High-grade squamous intraepithelial neoplasias Carcinomas Priority differentials: Sarcomas abscess with evidence of Mixed tumors systemic infection, toxic shock syndrome signs, and Leiomyomas necrotizing fasciitis Adenofibromas Mucinous cystadenomas Myxoid leiomyosarcoma Papillary tumors Primary neuroendocrine carcinoma  Management Goal: Preserve the gland and its function Empirical antibiotic treatment targeting both aerobic and anaerobic organisms (if cellulitis or fever is present) Incision and drainage (with or without placement of a Word catheter) are the most common first line treatments Pharmacological Treatment: Alcohol Sclerotherapy (fewer complications than silver nitrate), CO2 laser therapy (laser makes defect in cyst cavity to vaporize cyst contents, continuous drainage post procedure), Silver Nitrate (inexpensive option, as effective as traditional excision techniques, fewer complications/scarring, can cause chemical burning) Surgical treatment (Not first line treatment anymore, recurrence risk too high) ◦ Fistulization and Marsupialization (most commonly employed surgical techniques) ◦ Marsupialization and Window Operation- seek to create and maintain a patent fistula for cyst or abscess drainage. Cyst is excised in Marsupialization, and a window is cut into the cyst in the Window Operation Excision of the Bartholin’s gland- only if suspicion of malignancy or recurrent abscess. Lifespan Considerations and Complications Bartholin gland cysts and abscesses are most common in women of reproductive age. Complications: Cyst reoccurrence often follows incision and drainage or aspiration alone Gland excision may be accompanied by hemorrhage , hematoma formation or trauma to surrounding tissues, rectovaginal fistula, scarring, a long healing process, dyspareunia. Toxic shock syndrome is a rare complication, but noted in literature. Usually treated outpatient, but systemic infection or complications may warrant hospitalization Refer patient to experienced surgeon for therapy, if healthcare provider is not comfortable managing the Bartholin gland cyst or abscess. Patient and Family Education Explain basic physiology of the Bartholin gland and pathophysiology involved in cyst or abscess Discuss treatment options and explanations of what to expect after a treatment is used. Example: After CO2 laser therapy patients are instructed to refrain from sexual activity for 2 weeks. Post op discomfort managed with saltwater soaks Expected of 2-3 days of drainage of mucus after certain procedures until the cyst/abscess resolves. Proper hygiene, sitz baths, soaks, condom use strategies to prevent future Bartholin gland cyst or abscess.