EpistemisPainful swelling of the Bartholin's gland
Specialty: Gynecology and breast.
Why it occurs
- Obstruction of the excretory duct of the Bartholin gland with mixed bacterial superinfection (Staphylococcus aureus, Escherichia coli, Bacteroides spp.)
- Infection with Neisseria gonorrhoeae or Chlamydia trachomatis
- Chronic infected Bartholin's cyst
- Adenocarcinoma of the Bartholin gland (very rare, to be considered in postmenopausal women with indurated solid mass)
Initial workup
Eminently clinical diagnosis through physical examination. Sampling of pus by aspiration or during surgical drainage for common bacteriological culture and smear for Chlamydia and Neisseria gonorrhoeae by PCR. Biopsy of the wall of the cyst/abscess during the intervention if the patient is over 40 years of age to rule out primary neoplasia of the gland.
red flags
High fever, chills, inability to walk or sit due to exquisite pain, extensive cellulitis of the perineal area with involvement of adjacent tissues, local skin necrosis or suspicion of perineal necrotizing fasciitis (Fournier's gangrene).
Standard management
- Amoxicillin/clavulanic acid 875/125 mg orally every 8 hours for 7 days associated with Ibuprofen 600 mg every 8 hours
- Clindamycin 300 mg orally every 6 hours in those allergic to penicillin
- In case of fluctuating abscess, the treatment of choice is surgical through incision and drainage with marsupialization or placement of a Word catheter (note: sitz baths with warm water can promote maturation and spontaneous drainage of the abscess).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 4
- Treatment options
- 3