Bartholin's glands (or larger vestibular glands) are important organs of the female reproductive system. The Danish anatomist Caspar Bartholin Secundus first described them in 1677.Their main function is to produce a mucous secretion that helps lubricate the vagina and vulva. The glands are located in the vestibule of the vulva, on either side of the external opening of the vagina. They are homologous to the bulbourethral (Cowper's) glands in males.
Bartholin gland pathology may present as an asymptomatic mass, causing only vulvar asymmetry. Symptomatic masses may present with severe tenderness, surrounding erythema, and edema. Cysts and abscesses often form in women of reproductive age and do not require treatment. Rarely, mass biopsy and resection may be needed if malignancy is suspected.
Structure and Function
The main function of the Bartholin glands is to produce a mucous secretion that lubricates the distal end of the vagina during sexual intercourse. The glands are activated after menstruation and are non-palpable. Each gland is oval in shape and averages 0.5 cm. A two-centimeter-long efferent duct connects each gland to the posterolateral aspect of the vaginal opening (between the hymen and the labia minora).
During embryogenesis, the urogenital sinus gives rise to the Bartholin glands, the bottom of the sinus, and most of its epithelium. The body of each Bartholin gland consists of mucous acini lined with simple columnar epithelium. Their efferent ducts are composed of transitional epithelium, which merges into squamous epithelium as the stoma opens into the sinus.
Blood supply and lymphatics
The external pyloric artery provides the blood supply to the Bartholin glands. Both glands drain into the superficial inguinal and pelvic lymph nodes.
The vagus nerve innervates the Bartholin glands.
Incision and drainage plus word catheter placement
A scalpel is used to make a midline incision in the cyst/abscess after applying a local anesthetic. The incision should not be made on the outside of the labia because of the risk of fistula formation.A Word catheter (a small, thin rubber tube with an inflated balloon end) is placed inside the cyst after its contents have been removed. The catheter can be left in place for up to four weeks for continued drainage and re-epithelialization of the new outflow tract.
A scalpel is used to make an elliptical incision in the vulvar mucosa and underlying bladder wall. Care must be taken not to incise the outer lip of the labia because of the risk of fistula formation. After drainage of the contents of the open cavity, the edges of the cyst cavity are sutured to the surrounding skin. This procedure forms a permanent open pocket and the new outflow tract will shrink over time as it heals.
Excision of a Bartholin's cyst or abscess may be required when in-office treatments fail. Potential complications include an increased risk of bleeding, postoperative infection, pain secondary to scar tissue, and complications from general anesthesia. Surgical removal of Bartholin's glands has not been shown to interfere with sexual function.A specialist should perform this procedure.
The surgeon uses a scalpel to make an elliptical incision in the vulvar mucosa. Care must be taken not to incise the cyst/abscess. Dissection using sharp and blunt methods separates the cyst/abscess from surrounding structures. At the base of the cyst the Bartholin gland is located. The blood supply can be ligated with either cautery or suture. The cyst/abscess can then be completely removed. Using a multi-layer closure, the area where the Bartholin's cyst/abscess was located is closed with interrupted sutures. The mucosal layer is closed with a simple running suture.
Other treatment methods
Carbon dioxide laser therapy can provide vaporization of the cyst in the outpatient setting. A study by Fambrini M et al. concluded that CO2 laser vaporization is a safe and effective way to completely treat a Bartholin's cyst.Silver nitrate ablation after cyst drainage was as effective as marsupialization and caused less scar formation in a prospective randomized trial.Procedures such as cyst/abscess formation and needle aspiration with or without alcohol sclerotherapy require further clinical investigation.
Bartholin gland cysts, abscesses, and masses can significantly affect a woman's life. Pain and swelling can prevent sitting, walking and intercourse. The diagnosis of Bartholin's cysts and abscesses is often clinical. Atypical masses may require further imaging (such as magnetic resonance imaging), tissue biopsy, or complete resection.
Bartholin gland cyst
Bartholin's cysts account for about 2% of all gynecological visits each year.A cyst may form as a result of obstruction of the excretory duct, leading to accumulation of mucus and enlargement of the gland. Cysts are often sterile and unilateral. They present as painless masses that are usually detected during a routine pelvic exam. Rarely, larger cysts can cause sexual discomfort or deformity of the vulva.
Asymptomatic cysts in healthy patients may receive conservative treatment.A cyst that ruptures and drains spontaneously may only require warm sitz baths. In some cases, the cysts can become enlarged and painful or infected. Treatment options are available to relieve symptoms as well as cosmetic concerns. Antibiotics may be necessary in case of secondary infection. Postmenopausal patients may need further investigations to rule out the possibility of cancer.
Bartholin gland abscess
Bartholin's gland abscesses can result from either an infected cyst or a primary gland infection. They usually present with severe pain and swelling, making sitting, walking and sexual intercourse difficult. Other signs and symptoms they present may include:
Acute, painful, unilateral swelling of the vulva
Erythema and swelling surrounding a fluctuating mass of the vulva
Sudden relief of symptoms after spontaneous massive evacuation/rupture
Pyrexia is not a common feature in healthy patients
A study by Kessous et al. has described the most common microbial pathogens associated with Bartholin's abscesses.Escherichia Coliwas the most frequently detected pathogen (43.6%), followed byStaphylococcusoneurea(6.4%), group BStreptococci(4.8%) andEnterococcus spp(4.8%). Less than 10% of cases were polymicrobial in origin.E. Coli-Positive cultures were more frequent in recurrent infections (56.8%) than in primary infections (37%).Sexually transmitted infections were rarely causative, but screening for chlamydial and gonococcal infection remains important in susceptible patients. Broad-spectrum antibiotic coverage is recommended in the absence of microbial susceptibility.
There are many options available to treat symptomatic Bartholin's cysts or abscesses. The most common interventions include incision, drainage with Word catheter placement, and abscess marsupialization. A systematic review by BJG Illingworth et al. found that current randomized trial evidence does not support the use of any single surgical method.The effects of other interventions, such as insertion of a rubber ring catheter, cavity closure, and alcohol sclerotherapy, have not yet been adequately studied.
Bartholin's cysts and abscesses can very rarely lead to complex and poorly understood complications, such as a rectal fistula or fistula of the rectal canal.
Benign Bartholin Gland Tumor
Benign solid lesions of the Bartholin gland are rarely seen in the literature. Histopathology of resected glands includes nodular hyperplasia and adenomas.
Bartholin gland carcinoma
Primary Bartholin gland carcinoma is rare, accounting for 1 to 5 percent of all vulvar malignancies.Its frequency is higher in women in their 60s.Atypical presentations should raise suspicion for possible carcinoma and merit consideration in the differential diagnosis of any enlarging asymptomatic vulvar mass in a postmenopausal woman. Malignant masses can also become attached to the underlying tissues.
A retrospective cohort study concluded that mass Bartholin's resection in postmenopausal women is not warranted as first-line treatment because the incidence of cancer is so low (0.114 per 100,000 woman-years). These patients may benefit from mass drainage and selective biopsy.
Adenocarcinomas and squamous cell carcinomas are the two most common histological types of primary Bartholin gland carcinoma. Other rarer types are transitional, adenoid-cystic, and undifferentiated carcinomas. Human papillomavirus (HPV) type 16 has previously been detected by polymerase chain reaction in squamous cell carcinomas.
A retrospective cohort study found that the incidence of Bartholin gland abscesses was low (0.13%) during pregnancy. There was no significant difference in the pathogens found in culture-positive samples from pregnant and non-pregnant women.
Bartholin's Gland. Illustrated by Emma Gregory
Bora SA, Condous G. Bartholin's, vulvar and perineal abscesses.Best Pract Res Clin Obstet Gynaecol.October 2009;23(5):661-6.[PubMed: 19647493]
Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A. Clinical Pathology of Bartholin's Glands: A Review of the Literature.Curr Urol.May 2015;8(1): 22-5.[PMC Free Article: PMC4483306] [PubMed: 26195958]
Heller DS, Bean S. Lesions of the Bartholin gland: a review.J Low Genit Tract Dis.October 2014;18(4): 351-7.[PubMed: 24914884]
Hill DA, Lense JJ. Clinic treatment of cysts and abscesses of the Bartholin gland.Am Fam Physician.1998 Apr 01;57(7): 1611-6, 1619-20.[PubMed: 9556648]
Aydogan Mathyk B, Aslan Cetin B, Cetin H. Sexual function after treatment of Bartholin gland abscess: A randomized trial of marsupialization and excision methods.Eur J Obstet Gynecol Reprod Biol.November 2018;230:188-191.[PubMed: 30308402]
Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, Scarselli G, Marchionni M. Carbon laser vaporization of the Bartholin gland cyst: a retrospective analysis of 200 cases.J Minim Invasive Gynecol.2008 May-June;15(3): 327-31.[PubMed: 18439506]
Ozdegirmenci O, Kayikcioglu F, Haberal A. Prospective Randomized Study of Marsupialization versus Silver Nitrate Application in the Management of Bartholin Gland Cysts and Abscesses.J Minim Invasive Gynecol.2009 March-Apr.16(2): 149-52.[PubMed: 19598336]
Marzano DA, Haefner HK. The Bartholin's cyst: past, present, and future.J Low Genit Tract Dis.2004 July;8(3): 195-204.[PubMed: 15874863]
Lee WA, Wittler M.StatPearls [Internet].StatPearls Publishing; Treasure Island (FL): January 30, 2023. Bartholin Gland Cyst. [PubMed: 30335304]
Kessous R, Aricha-Tamir B, Sheizaf B, Shteiner N, Moran-Gilad J, Weintraub AY. Clinical and microbiological features of Bartholin gland abscesses.Obstet Gynecol.October 2013;122(4): 794-799.[PubMed: 24084536]
Illingworth B, Stocking K, Showell M, Kirk E, Duffy J. Evaluation of treatments for Bartholin's cyst or abscess: a systematic review.BJOG.May 2020?127(6):671-678.[PubMed: 31876985]
[ PubMed ] Kim YS, Han HS, Seo MW, Kim WS, Lee JH, Park NK, Sang JH. Recto-Bartholin's duct fistula: a case report.Gynecol Obstet Invest.2015;79(2): 136-8.[PubMed: 25633604]
Hjortø SP, Pehrson C, Gernow A. [Nodular hyperplasia of the Bartholin gland].Weekly Laeger.22 Mar 2010;172(12):969-70.[PubMed: 20334800]
Tseng YA, Lawrence WD, Slater SE. Nodular hyperplasia of the Bartholin gland, a benign mimic of aggressive angiomyxoma: A case series and literature review.Int J Gynecol Pathol.November 2018;37(6):554-558.[PubMed: 28914673]
Wu JC, Xi ML, Wang YQ, Tang WB, Zhang YQ. Primary small cell neuroendocrine carcinoma of the Bartholin gland: A case report.Oncol Lett.October 2018;16(4):4434-4438.[PMC free article: PMC6126345] [PubMed: 30197672]
Heine O, Vahrson H. [Primary Bartholin gland cancer].Obstetrics Frauenheilkd.1987 Jan.47(1): 35-40.[PubMed: 3569825]
Visco AG, Del Priore G. Bartholin gland enlargement after menopause: cancer risk assessment in a hospital setting.Obstet Gynecol.February 1996?87(2): 286-90.[PubMed: 8559540]
[ PubMed ] Felix JC, Cote RJ, Kramer EE, Saigo P, Goldman GH. Bartholin gland carcinomas. Histogenesis and etiologic role of human papillomavirus.Am J Pathol.1993 Mar;142(3):925-33.[PMC Free Article: PMC1886794] [PubMed: 8384409]
Boujenah J, Le SNV, Benbara A, Bricou A, Murtada R, Carbillon L. Bartholin gland abscess during pregnancy: Report on 40 patients.Eur J Obstet Gynecol Reprod Biol.May 2017;212:65-68.[PubMed: 28342391]
The glands are located in the vulvar vestibule, at either side of the external orifice of the vagina. They are homologous to the bulbourethral (Cowper's) glands in males. Bartholin gland pathology may present as an asymptomatic mass, causing only vulvar asymmetry.How do you unclog a Bartholin gland? ›
Soaking in a tub filled with a few inches of warm water (sitz bath) several times a day for three or four days may help a small, infected cyst to rupture and drain on its own. Surgical drainage. You may need surgery to drain a cyst that's infected or very large.What is Bartholin gland problems? ›
Bartholin gland cysts, abscesses, and masses may significantly affect a woman's life. Pain and swelling can prevent sitting, walking, and intercourse. The diagnosis of Bartholin cysts and abscesses is often clinical. Atypical masses may require imaging (such as magnetic resonance), tissue biopsy, or complete excision.What causes Bartholin glands to become blocked? ›
If the ducts become blocked, they can fill with fluid and expand to form a cyst. It's often not known why the ducts become blocked, but sometimes it's linked to sexually transmitted bacterial infections (STIs), such as gonorrhoea or chlamydia, or other bacterial infections, such as Escherichia coli (E. coli).What side is Bartholin gland? ›
The Bartholin's glands are located on each side of the vaginal opening. They secrete fluid that helps lubricate the vagina.What happens when Bartholin gland is blocked? ›
A Bartholin cyst develops when a blockage occurs in a Bartholin gland in the vagina. This blockage causes a lump that can cause irritation and pain during walking, sitting or sex. Bartholin cysts can resolve on their own over time. If it becomes infected, it may need treated by a healthcare provider.What does a clogged Bartholin gland look like? ›
You may notice a round bulge on one of your vaginal lips, near the opening of the vagina. It may be painless or slightly tender. It may stay the same size or may slowly grow larger. Cysts that get infected are usually very tender.What are the side effects of removing the Bartholin gland? ›
- Hematoma (blood that collects at the surgical site)
- Pain during sexual activity (dyspareunia)
What is drainage of a Bartholin cyst/abscess? Draining a Bartholin cyst/abscess involves making an incision into the lump and draining the fluid or pus out. If the procedure is planned it is carried out under general anaesthetic (you are asleep).When should Bartholin gland be removed? ›
If the cyst becomes infected with bacteria, a Bartholin's abscess is formed. This can be very large and painful. It can be treated in the office. However, if this forms repetitively or does not respond to office treatment, you will be scheduled for a Bartholin's Gland Excision.
Adenoid cystic carcinoma of Bartholin's gland is a rare malignant tumor of female genital tract.Can a swollen Bartholin gland go away on its own? ›
Some Bartholin gland cysts go away without treatment. You can take a non-prescription pain medicine such as ibuprofen (Advil or Motrin, for example) to relieve mild discomfort. To help healing, soak the area in a shallow, warm bath, or a sitz bath. This can help a cyst drain and heal on its own.What are natural remedies for Bartholin gland? ›
- Tea tree oil: Applying a mixture of tea tree oil and castor oil to the abscess may encourage drainage. Tea tree oil has natural antibacterial properties. ...
- Apple cider vinegar (ACV): Typically, people who use ACV to treat a Bartholin's abscess dilute it and apply it to the cyst with a cotton ball.
When referring to the female reproductive system, the Bartholin glands are responsible for constantly producing a clear lubricating fluid. The amount of lubrication increases in response to sexual stimulation.Can a Bartholin gland burst? ›
Bartholin gland abscesses usually develop over two to four days and can become larger than 8 cm. They tend to rupture and drain after four to five days.Where does Bartholin gland drain? ›
Bartholin's glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the 4 o'clock and 8 o'clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops.Do you need your Bartholin glands? ›
Your Bartholin glands are two small glands located on both sides of your labia (vaginal lips) near the opening of your vagina. They secrete fluid that helps lubricate your vagina. Bartholin cysts form when a blockage occurs at the opening of one of these glands, causing fluid to build up and form a lump.Can stress cause a Bartholin cyst? ›
It's not known whether Bartholin cysts are caused by stress. Since Bartholin glands only start functioning at puberty and shrink after menopause, Bartholin cysts usually affect sexually active women between 20 and 30.Are Bartholin cysts hard or soft? ›
A Bartholin's cyst is a small fluid-filled sac that develops in the skin, on either side of the vagina opening. It's a soft, painless lump that doesn't usually cause problems.How painful is Bartholin gland removal? ›
After surgery, you may have pain and discomfort in your vulva for several days. It may be uncomfortable to sit for long periods of time. You may also have pain if your urine comes into contact with your wound. Your doctor may have put a small rubber tube, called a catheter, in the cut (incision).
You can expect to feel better and stronger each day. But you may get tired quickly and need pain medicine for a week or two. You may need about 2 to 4 weeks to fully recover.How much does it cost to remove Bartholin gland? ›
On MDsave, the cost of a Bartholin's Cyst Removal ranges from $3597 to $6038. Those on high deductible health plans or without insurance can shop, compare prices and save. Read more about how MDsave works.Can a gynecologist drain a Bartholin cyst? ›
The removal of Bartholin's cysts is also a possible treatment procedure. However, gynecologists rarely use this form of treatment.What is inside a Bartholin cyst? ›
Bartholin abscess is the buildup of pus that forms a lump (swelling) in one of the Bartholin glands. These glands are found on each side of the vaginal opening. External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris.Can tight pants cause Bartholin cyst? ›
Wearing a tight-fitting thong day after day can irritate and inflame the area around the Bartholin's glands, which produce lubrication during intercourse. Should the ducts that lead to the glands get clogged, you could develop a cyst right next to your vagina, says Jennifer R.What happens if you don't remove a Bartholin cyst? ›
A Bartholin's cyst can become infected, forming an abscess. A number of bacteria may cause the infection, including Escherichia coli (E. coli) and bacteria that cause sexually transmitted infections such as gonorrhea and chlamydia.Can you get a Bartholin cyst without having an STD? ›
A Bartholin's cyst is not a sexually transmitted disease (STD). In rare cases, a Bartholin's cyst may be caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea. However, the cyst itself is not sexually transmitted.Can Bartholin cysts spread? ›
Most of the time, Bartholin gland cysts are not infected and can't be spread to others. In some cases, however, they can be caused by an infection, or they may get infected after they get bigger.Is it OK to leave a Bartholin cyst? ›
If it turns out to be a Bartholin's cyst and it does not bother you, it's often better to leave it alone. If the cyst is painful, a GP may recommend: soaking the cyst for 10 to 15 minutes in a few inches of warm water (it's easier in the bath) – it's best to do this several times a day for 3 or 4 days if possible.Can UTI cause Bartholin cysts? ›
Many types of germs (bacteria) can infect a Bartholin's cyst or gland to cause an abscess. Most are the common germs that cause skin or urine infections, such as Staphylococcus spp. and Escherichia coli. So, any woman can develop a Bartholin's abscess.
Causes of Bartholin's Cyst
The infection that causes the cyst may result from bacteria such as E. coli. In rare cases, it may be due to bacteria that cause sexually transmitted infections (STIs) like gonorrhea or chlamydia. About two out of 10 women can expect to get a Bartholin's gland cyst at some point.
Medication and antibiotics are used to treat Bartholin's abscesses as the infection is mostly caused by pathogens. Antibiotic therapy may not be necessary for healthy women with uncomplicated abscesses. Antibiotic therapies include Ceftriaxone, Ciprofloxacin, Doxycycline and Azithromycin.Does a heating pad help a Bartholin cyst? ›
Apply a warm compress to your cyst. This may relieve swelling and pain. A warm compress will also help open your Bartholin glands so they drain normally.What foods help Bartholin cysts? ›
The recurring cyst formation is not associated with any particular dietary intake, thus there is no need for any food restrictions.Should I massage a Bartholin cyst? ›
Pain relievers should be used as necessary to diminish the discomfort. The application of a hot towel or handkerchief or napkin to the area for the purposes of massaging the swelling can similarly be beneficial. Usually, such a massage will give the patient a soothing feeling as well.What do the Bartholin glands open into? ›
The Bartholin's glands are located on the inferior and lateral surface of the vulva; they open into the vagina and produce a thin mucus that helps to lubricate the vagina.What is the most common cause of Bartholin gland abscess? ›
The abscess is formed due to infection of the fluid accumulated inside the blocked duct. Fluid may upsurge over many years before abscess forms.  Most of Bartholin's gland abscesses have been found to be caused by microorganisms that colonize the perineal region.Does Bartholin cyst smell? ›
If the cyst becomes infected, it can cause a painful collection of pus (abscess) to develop in one of the Bartholin's glands. Signs of an abscess include the affected area becoming red, swollen, tender and hot. You may also notice some smelly discharge or pus leaking from the area.How does a woman get a Bartholin cyst? ›
What Is Bartholin's Cyst? Girls and women have two Bartholin glands that are located just inside the opening of the vagina. The glands produce fluid that lubricates the vagina. A Bartholin gland cyst forms when the opening of the gland becomes blocked and the fluid cannot get out.What is the main function of the Bartholin's glands? ›
The fact that Bartholin's glands supply a mucus for the lubrication of the entrance to the vagina during sexual excitement, and that Cowper's glands secrete a mucous fluid which acts in part as a vehicle for the seminal discharge has long been noted.
You may notice a round bulge on one of your vaginal lips, near the opening of the vagina. It may be painless or slightly tender. It may stay the same size or may slowly grow larger. Cysts that get infected are usually very tender.What is the difference between Bartholin cyst and Bartholin gland? ›
Bartholin glands are found on each side of the vaginal opening. A Bartholin cyst is a buildup of fluid that occurs if the opening of the gland is blocked. A Bartholin abscess may occur if the cyst fluid becomes infected. The Bartholin cyst or abscess appears as a lump or swelling on the side of the vaginal opening.Can a Bartholin cyst come back after gland removal? ›
Marsupialization has an excellent success rate of resolving Bartholin cysts for good. Bartholin cysts return after marsupialization in only 2% to 13% of cases.How long does it take to recover from Bartholin gland removal surgery? ›
You can expect to feel better and stronger each day. But you may get tired quickly and need pain medicine for a week or two. You may need about 2 to 4 weeks to fully recover.How much fluid does the Bartholin gland produce? ›
Fluid from the Bartholin's glands is combined with other vaginal secretions as a "lubrication fluid" in the amount of about 6 grams per day, and contains high potassium and low sodium concentrations relative to blood plasma, with a slightly acidic pH of 4.7.Where does the Bartholin gland drain? ›
Bartholin's glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the 4 o'clock and 8 o'clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops.What is the home remedy for Bartholin gland swelling? ›
Soaking in a few inches of warm water — either in a tub or sitz bath — four times a day for a few days may resolve even an infected Bartholin cyst. Taking over-the-counter painkillers, such as naproxen (Aleve, Naprosyn), acetaminophen (Tylenol), or ibuprofen (Advil, Motrin), may help with discomfort.Can a UTI cause a Bartholin cyst? ›
Many types of germs (bacteria) can infect a Bartholin's cyst or gland to cause an abscess. Most are the common germs that cause skin or urine infections, such as Staphylococcus spp. and Escherichia coli. So, any woman can develop a Bartholin's abscess.Is Bartholin cyst danger? ›
A Bartholine cyst is dangerous regardless of the size of the cyst, how painful it is, and whether the cyst is infected. These are also the criteria for the doctor to choose the treatment plan, after having an accurate diagnosis. Sometimes patients just need to treat at home according to the doctor's instructions.