Bartholin's Abscess

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HISTORY
  • 24 year old woman
  • Presented with painful vulvar swelling for a few days
  • 5 days previously she had been sexually assaulted by a group of men

EXAMINATION


 

DIAGNOSIS

Bartholin’s gland abscess

She was referred to the Emergency Department at the Royal Womens Hospital, where  the abscess was incised, drained and marsupialized.  Streptococcus pyogenes was isolated from the pus.

THE LESSON
  • Bartholin’s glands are the female homologues of Cowper’s glands in men.

This list of homologues (courtesy of Wikipedia) of the human reproductive system shows how indifferent embryonic organs differentiate into the respective sex organs in males and females. Mullerian ducts are also referred to as paramesonephric ducts, and Wolffian ducts as mesonephric duct.

 Indifferent   Male   Female
 Gonad  Testis  Ovary
 Mullerian duct   Prostatic utricle   Uterus, proximal vagina
 Wolffian duct  Rete testis  Rete ovarii
 Mesonephric tubules  Efferent ducts  Epoophoron
 Wolffian duct  Epididymis  Gartner’s duct
 Wolffian duct   Vas deferens   
 Wolffian duct   Seminal vesicle   
 Wolffian duct  Prostate  Skene’s glands
 Urogenital sinus   Bladder, urethra  Bladder, urethra, distal vagina
 Urogenital sinus  Cowper’s or Bulbourethral gland  Bartholin’s gland
 Genital swelling  Scrotum  Labia majora
 Urogenital folds  Spongy urethra   Labia minora
 Genital tubercle  Penis  Clitoris
 Prepuce  Foreskin  Clitoral hood
   Bulb of penis  Vestibular bulbs
   Glans penis  Clitoral glans
   Crus of penis  Clitoral crura
   processus vaginalis   Canal of Nuck




























  • Abscesses of Bartholin’s glands may arise either spontaneously, in which case the infection is almost always polymicrobial, or as a results of gonococcal or chlamydial infection.  Streptococcal infection is uncommon.
  • Treatment is surgical.  Antibiotics are indicated only if there is significant surrounding cellulites, or an organism of public health importance eg gonococci, chlamydia and Streptococcus pyogenes.

    Marsupialization involves excising the cyst wall and suturing the edges to the vulvar mucosa, to form a shallow cavity which remains open and can drain freely

    Another technique popular in the US (but not in Australia) is the placement of a Word catheter.

    This is a small latex catheter inserted through an incision into the abscess cavity. The balloon is inflated with water or gel and the free end is tucked into the vagina.

    This is left in place for 4 weeks, by which time a new drainage tract will have re-epithelialized.

Updated November 2007