9/8/2015

BartholinGlandDiseases:Background,Pathophysiology,Epidemiology

BartholinGlandDiseases
Author:AntoniaQuinn,DOChiefEditor:ErikDSchraga,MDmore...
Updated:Aug08,2014

Background
BartholinglandswerefirstdescribedbyCasparBartholin,aDutchanatomist,in
1677.Thesepairedglandsareapproximately0.5cmindiameterandarefoundin
thelabiaminorainthe4and8oclockpositions.Typically,theyarenonpalpable.
Eachglandsecretesmucusintoa2.5cmduct.Thesetwoductsemergeontothe
vestibuleateithersideofthevaginalorifice,inferiortothehymen.Theirfunctionis
tomaintainthemoistureofthevaginalmucosa'svestibularsurface.
ThisarticlefocusesonthemostcommonBartholinglanddiseases,cystsand
abscesses.Althoughrare,carcinomaoftheglandshouldbeconsideredinwomen
withanatypicalpresentation.

Pathophysiology
Bartholinglandsareknowntoformcystsandabscessesinwomenofreproductive
age.Cystsandabscessesareoftenclinicallydistinguishable.Bartholincystsform
whentheostiumoftheductbecomesobstructed,leadingtodistentionofthegland
orductwithfluid.Obstructionisusuallysecondarytononspecificinflammationor
trauma.Thecystisusually13cmindiameterandoftenasymptomatic,although
largercystsmaybeassociatedwithpainanddyspareunia. [1]
Bartholinabscessesresultfromeitherprimaryglandinfectionorinfectedcyst.
Patientswithabscessescomplainofacute,rapidlyprogressivevulvarpain.Studies
haveshownthattheseabscessesareusuallypolymicrobialandrarelyattributableto
sexuallytransmittedpathogens.
AdenocarcinomaoftheBartholinglandsisrare,accountingfor12%ofallvulvar
malignancies.Typically,thislesionpresentsasagraduallyenlargingglandinan
asymptomatic,postmenopausalwoman. [2]

Epidemiology
Frequency
UnitedStates
Approximately2%ofwomenofreproductiveagewillexperienceswellingofoneor
bothBartholinglands.

Mortality/Morbidity
Bartholinglanddiseasesarerarelycomplicatedbysystemicinfection,sepsis,and
bleedingsecondarytosurgicaltreatment.Misseddiagnosisofmalignancymay
resultinpooreroutcomeforthosepatients.

Sex
Bartholinglandsarepresentonlyinfemales.

Age
Thesediseasestypicallyoccurinwomenbetweentheagesof20and30years.
Bartholinglandenlargementinpatientsolderthan40yearsisrareandshouldbe
referredtoagynecologistforpossiblebiopsy.
ClinicalPresentation

ContributorInformationandDisclosures
Author
AntoniaQuinn,DOAssistantProfessor,DepartmentofEmergencyMedicine,StateUniversityofNewYork
DownstateMedicalCenterAssistantResidencyDirector,AttendingPhysician,DepartmentofEmergency
Medicine,KingsCountyHospitalCenter,SUNYDownstateMedicalCenter
AntoniaQuinn,DOisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysicians,

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BartholinGlandDiseases:Background,Pathophysiology,Epidemiology

AntoniaQuinn,DOisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysicians,
SocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference
Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
RichardHSinert,DOProfessorofEmergencyMedicine,ClinicalAssistantProfessorofMedicine,Research
Director,StateUniversityofNewYorkCollegeofMedicineConsultingStaff,ViceChairinChargeofResearch,
DepartmentofEmergencyMedicine,KingsCountyHospitalCenter
RichardHSinert,DOisamemberofthefollowingmedicalsocieties:AmericanCollegeofPhysicians,Society
forAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
ChiefEditor
ErikDSchraga,MDStaffPhysician,DepartmentofEmergencyMedicine,MillsPeninsulaEmergencyMedical
Associates
Disclosure:Nothingtodisclose.
AdditionalContributors
JosephJSachter,MD,FACEPConsultingStaff,DepartmentofEmergencyMedicine,MuhlenbergRegional
MedicalCenter
JosephJSachter,MD,FACEPisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanAssociationforPhysician
Leadership,AmericanMedicalAssociation,SocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
Acknowledgements
HowardABlumstein,MD,FAAEMAssistantProfessorofSurgery,MedicalDirector,DepartmentofEmergency
Medicine,WakeForestUniversitySchoolofMedicine
HowardABlumstein,MD,FAAEMisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanMedicalAssociation,Emergency
MedicineResidentsAssociation,andSocietyforAcademicEmergencyMedicine
Disclosure:Nothingtodisclose.
MTysonPillow,MDAssistantDirectorofMedicalEducation,BenTaubGeneralHospitalEmergencyCenter
AssistantProfessor,BaylorCollegeofMedicine
MTysonPillow,MDisamemberofthefollowingmedicalsocieties:AirMedicalPhysicianAssociation,American
CollegeofEmergencyPhysicians,AmericanMedicalAssociation,AmericanMedicalStudent
Association/Foundation,EmergencyMedicineResidentsAssociation,SocietyforAcademicEmergency
Medicine,andStudentNationalMedicalAssociation
Disclosure:Nothingtodisclose.
JenniferColesSchecter,MDStaffPhysician,DepartmentofEmergencyMedicine,LaheyClinic,Burlington,
MA
Disclosure:Nothingtodisclose.

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