BARTHOLIN’S ABSCESS

Bartholin’s glands are located bilaterally in the vulva, adjacent to the vaginal orifice.

Cysts arise when the glands’ ducts become occluded. Bartholin’s abscesses occur when the gland becomes secondarily infected with one of many common bacterial pathogens.

Clinical Features

Patient may complain of any combination of symptoms that include;

  • Local pain
  • Low-grade fever
  • Perineal discomfort
  • Labial swelling
  • Dyspareunia
  • Purulent PV discharge
  • Difficulty in sitting.

Physical examination may reveal tender, fluctuant abscess lateral to and near the posterior fourchette, local swelling,
erythema, labial oedema, and painful inguinal adenopathy.

Most abscesses develop over 2–3 days and spontaneous rupture often occurs within 72 hours.

Management

  • Treatment of acute phase includes bed rest, analgesics, e.g, PO ibuprofen 400mg TDS for 5 days, hot wet compresses.
  • PO doxycycline, 100mg BD for 7 days, then re-evaluate.
  • When abscess formation is obvious, incision and drainage as follows:
    • Apply local anaesthesia lignocaine 1%.
    • Incise distended mucosa as close to hymenal ring as possible or through skin if point of abscess is obvious.
    • Marsupialize to prevent recurrence.
    • Pack cavity with gauze impregnated with liquid paraffin for 24 hours.
  • Continue with warm sitz (saline) baths till the wound is healed.