Bartholin gland

**Anatomy/Embryology** - Paired pea-sized glands in the deep perineal pouch/posterolateral to the vaginal opening, at the 4 and 8 o'clock positions. Ducts (~2 cm) open into the vestibule in the groove between the hymen and labia minora. - Lined by cuboidal epithelium (gland) and transitional epithelium (duct near the gland); the distal duct is lined by squamous epithelium. - Embryologic origin: urogenital sinus (endoderm). Homologue of the male bulbourethral (Cowper) glands. - Blood supply: internal pudendal artery. Innervation: pudendal nerve. - Not to be confused with Skene (paraurethral/lesser vestibular) glands, which are homologous to the prostate.

**Function** - Secrete mucoid fluid that provides vaginal/vestibular lubrication during sexual arousal. They are not responsible for the majority of vaginal lubrication (which is mainly a transudate from vaginal wall blood vessels).

**Pathology** - *Bartholin duct cyst*: duct obstruction (often from inflammation, trauma, or mucus inspissation) causes retention of mucus, producing a usually painless, unilateral cystic swelling at the posterior introitus. - *Bartholin abscess*: a cyst becomes infected, giving a painful, tender, fluctuant, erythematous swelling, with dyspareunia and difficulty walking or sitting. Usually polymicrobial (E. coli, anaerobes, staphylococci, streptococci); also consider *Neisseria gonorrhoeae* and *Chlamydia trachomatis*, so test for STIs. - *Bartholin gland carcinoma*: rare. Consider in women over 40 with a new or persistent Bartholin mass, in which case biopsy is needed. Types include squamous cell carcinoma (most common), adenocarcinoma, and adenoid cystic carcinoma.

**Management** - Asymptomatic cyst: observation. - Symptomatic cyst or abscess: incision and drainage with Word catheter placement (stays 4 to 6 weeks to allow epithelialization of a new tract). Alternatives include marsupialization, silver nitrate ablation, CO2 laser, and (for recurrent cases) gland excision. - Antibiotics are generally not needed after drainage unless there is cellulitis, systemic signs, immunocompromise, or an STI risk. Treat STIs if identified. - Simple needle aspiration or I&D alone has a high recurrence rate.

**High-yield pearls** - Location: 4 and 8 o'clock. - Homologue: bulbourethral (Cowper) gland in males. Skene gland corresponds to the prostate. - Postmenopausal or older woman with a Bartholin mass: biopsy to rule out cancer. - Classic vignette: a sexually active woman with acute unilateral, painful labial swelling at the posterior introitus, treated with I&D and Word catheter.