VULVAL SWELLING

The diagnosis is of a Bartholin’s abscess. The Bartholin’s glands are located in the pos-terior vulva and the gland ducts open into the lower vagina to maintain a moist vaginal surface, important during intercourse. Obstruction to a duct by inflammation (from fric-tion during intercourse) or infection causes a cyst to develop, which commonly becomes infected. Usually mixed flora is found but in 20 per cent of cases gonorrhoea is isolated.

The diagnosis is clinical and it is important to differentiate a Bartholin’s cyst from the dif-ferential diagnosis of a sebaceous cyst, vaginal wall cyst or perianal abscess.

Management

The abscess must be drained, traditionally by formal incision and drainage, with the edges of the cyst capsule sutured to the skin to prevent reclosure of the duct (marsupialization). Alternatively a Word catheter can be inserted for 4 weeks, which acts to allow continued abscess drainage and encourage epithelialization of the tract to provide a long-term drainage route for the gland. In most cases antibiotics are not needed after drainage, unless there is surrounding erythema or systemic signs of sepsis are present. In this case the girl has had several recent partners and a general sexually transmitted infection screen should be arranged after drainage of the cyst, with general sexual health advice. She should also be advised that Bartholin’s abscesses may recur, even after marsupialization.

KEY POINTS

• Bartholin’s abscesses are relatively common and cause acute painful unilateral vulval swelling.

• Drainage of the abscess and marsupialization of the skin edges are the mainstay of treatment but recurrence is still common.

• Pus should always be sent for culture as gonorrhoea is isolated from up to 20 per cent of Bartholin’s abscesses.