Bartholin cyst and abscess

Definition

Bartholin's Cyst and Abscess

• Location: The Bartholin's gland duct opens in the posterior third of the introitus, at approximately the 5 and 7 o'clock positions.
• Pathogenesis of the cyst: It forms due to obstruction of the excretory duct with secretion build-up.
• Clinical presentation of the abscess: A characteristic finding is a tense, extremely painful, reddened swelling that impedes walking.

• A Bartholin cyst forms when the duct of the Bartholin gland is obstructed and mucus accumulates; infection of a cyst or of the gland itself produces a Bartholin abscess.
• The two pea-sized (about 0.5 cm) glands, normally not palpable, lie at the lower posterior sides of the vaginal opening, at about 4 and 8 o'clock; their 2.0–2.5 cm ducts open between the labia minora and the hymenal edge.

Occurrence & epidemiology

Epidemiology

• Cysts and abscesses usually occur after the onset of puberty; Bartholin cysts develop in about 3 % of women, usually in their 20s.
• Abscesses are almost three times more common than cysts alone.
• Incidence decreases after the menopause, when the possibility of malignant transformation becomes more relevant, especially in recurrent or complex cases.

Aetiopathogenesis

Aetiology and risk factors

• Bartholin abscesses are polymicrobial; Escherichia coli is the single most common pathogen identified on culture.
• Rarely, the infection is caused by a sexually transmitted pathogen such as Neisseria gonorrhoeae.

Clinical features

• Most cysts are asymptomatic, non-tender, unilateral and palpable near the vaginal orifice; large cysts can cause pressure or pain and interfere with sexual activity, sitting or walking.
• Abscesses cause severe vulvar pain and sometimes fever; they are tender and typically erythematous, and surrounding cellulitis and vaginal discharge may also occur.

Diagnosis

Typical imaging findings

• Clinical finding: A smooth, tense, unilateral swelling bulges from the posterior third of the labium majus and displaces the introitus sideways. The overlying skin is not red and the other side is normal.

• The diagnosis is usually made by examination of the vulva; typical findings are a unilateral, medially protruding mass in the posterior vulva with vulvar asymmetry and, in abscesses, overlying erythema, induration or fluctuance.
• Bartholin gland carcinoma is rare; a solid or fixed mass raises suspicion of malignancy.

Keep learning in the app

Further reading (selection)

1. StatPearls: Bartholin Gland Cyst (NCBI Bookshelf)
2. MSD Manual Professional: Bartholin Gland Cyst and Bartholin Gland Abscess
3. Recurrent Bartholin Abscess Resulting in Rare Suspected Recto-Bartholin Fistula: A Case Report (2026, PubMed Central)
4. DocCheck Flexikon, Bartholinitis

Cross-references