Family physicians can look forward...

Family physicians can look forward to to encounter Bartholin's duct pouchs or gland abscesses in their female patients. These often met with problems often can be resolv with the use of simple office-based steps such as Word catheter placement for canal cysts or gland abscesses, and marsupialization for tube cysts.

Anatomy

Bartholin's glands (greater vestibular glands) are homologue of the Cowper's glands (bulbourethral glands) in males. (1) At puberty, these glands begin to function, providing moisture for the vestibule.

The Bartholin's glands perform the operations indicated in from buds in the epithelium of the posterior area of the vestibule. The glands are located bilaterally at the base of the labia minora and drain between the sides of 2- to 2.5-cm-long ducts that devoid into the vestibule at about the 4 o'clock and 8 o'clock positions (23) (Figure 1) The glands are usually the size of a pea and rarely exce 1 cm They are not palpable leave out in the presence of disease or infection.

Epidemiology

Bartholin's channel cysts, the most common cystic putting outs in the vulva, (4,5) come to one's mind in the labia majora. (6) sum of two units percent of women develop a Bartholin's conduit cyst or gland abscess at any time in life. (6) Abscesses are almost three times more often met with than cysts. One case-control contemplation (7) found that white and black women were more likely to bring out Bartholin's cysts or abscesses than Hispanic women and that women of high parity were at lowest risk.

Gradual involution of the Bartholin's glands can befall by the time a woman reaches 30 years of age. (8) This may account for the more every-day occurrence of Bartholin's duct sacs and gland abscesses during the reproductive years, especially between 20 and 29 years of age.

Because a vulvar mass in a postmenopausal woman can be cancer, excisional biopsy may be required. an investigators (9) have suggested that surgical excision is unnecessary because of the reasonable risk of Bartholin's gland cancer (0114 cancers by means of 100,000 woman-years). However, if the diagnosis of cancer is delayed, the prognosis can be poor.

Pathology

Obstruction of the distal Bartholin's conduit may result in the retention of secretions, with resultant dilation of the tube and formation of a sac The cyst may become infected, and an abscess may exhibit in the gland. A Bartholin's conduit cyst does not necessarily have to be near before a gland abscess cause to grows (10)

Bartholin's gland abscesses are polymicrobial (Table 1) (41112) Although Neisseria gonorrhoeae is the predominant aerobic isolate, anaerobes are the mostly common pathogens. (10,11,13) Chlamydia trachomatis also may be a causative organism. (14) However, Bartholin's channel cysts and gland abscesses are no longer considered to be exclusively the be derived of sexually transmitted infections. (4) Vulvovaginal surgery is an rare cause of these cysts and abscesses. (15)

Presentation

If a Bartholin's conduit cyst remains small and does not become inflamed, it may be asymptomatic. However, the pouch typically presents as a medially protruding mass in the posterior introitus in the region where the channel opens into the vestibule. (10) If the pouch becomes infected, an abscess may form in the gland (Figure 2) (10) Induration usually is ready around the gland, (10) and walking, sitting, or sexual intercourse may accrue in vulvar pain.

Bartholin's pipe cysts and gland abscesses must be differentiated from other vulvar masses. (16810) The greatest in number common cystic and solid vulvar lesions are listed in Table 2 Because the Bartholin's glands usually shrink during menopause, a vulvar germination in a postmenopausal woman should be evaluated for malignancy, especially if the mass is irregular, nodular, and persistently indurated. (10)

Treatment

The treatment of a Bartholin's pipe cyst depends on the patient's symptoms. An asymptomatic pouch may require no treatment, (2) nevertheless symptomatic Bartholin's duct cysts and gland abscesses require drainage. Unles spontaneous break occurs, an abscess rarely unravels on its own.

Although incision and drainage is a relatively quick and easy process that provides almost immediate relief to the patient, this approach should be discouraged because there is a propensity for the cyst or abscess to return (1,5,16) One investigator (17) reported a 13 percent failure rate for the measure Furthermore, incision and drainage may make later Word catheter placement or marsupialization difficult. (116)

Definitive drainage involves Word catheter placement for Bartholin's tube cysts and gland abscesses, and marsupialization for tube cysts.

WORD CATHETER

A Word catheter is commonly used to treat Bartholin's conduit cysts and gland abscesses. (12) The pedicel of this rubber catheter is 1 inch lengthy and the diameter of a no. 10 French Foley catheter. The small, inflatable balloon tip of the Word catheter can grasp about 3 mL of saline (Figure 3)

After sterile preparation and the administration of a local anesthetic, the wall of the sac or abscess is grasped with a small forceps, and a no. 11 blade is used to make a 5-mm (stab) incision into the sac or abscess (2,16) (Table 3) It is important to grasp the pouch wall before the incision is made; otherwise the pouch can collapse, and a false tract may be created. (16) The incision should be within the introitus external to the hymenal ring in the area of the pipe orifice. (10,16) If the incision is too large, the Word catheter will fall out