Bartholinitis

The Bartholin, or greater vestibular, glands are paired, pea-sized mucin-secreting glands situated posterolaterally in the vestibule. Each gland drains through a single duct approximately 2 to 2.5 cm long. The ducts open near the vaginal introitus at about the 4 and 8 o'clock positions, where their secretion lubricates the vestibule. A Bartholin duct cyst begins with obstruction of the duct orifice. Mucus continues to accumulate behind the blockage, producing a localized cyst. The cyst is an obstructive lesion, not primarily an infection, and remains sterile until secondary bacterial infection occurs. Once infected, the collection becomes an abscess: painful, inflamed, and often fluctuant. This mechanism explains why antibiotics alone are inadequate for a true abscess. The infected material is walled off, so source control requires opening and draining the cavity. Antibiotics are an adjunct only when the clinical situation creates a separate indication for them. Bartholin abscesses are usually polymicrobial. Escherichia coli and Staphylococcus aureus are recovered most often, with vaginal and enteric flora predominating. Sexually transmitted pathogens account for only a minority of cases, although a sexually transmitted infection may...