Snapshot A 39-year-old female comes her primary care physician complaining of vaginal pain. She reports that for a month she has had increased swelling of her labia. She has been trying to lose weight, and now the pain is affecting her ability to run and bike. It also hurts to have sex. She denies abnormal discharge. Her last menstrual period was 10 days ago and they occur regularly every month. On physical exam, there is swelling of the left labia, most prominently at the posterior vestibule. Introduction Clinical definition fluid collections that form in the Bartholin glands exocrine glands located 4 o’clock and 8 o’clock positions in labia minora Epidemiology Demographics occurs in women of child-bearing age incidence increases from puberty to menopause Etiology Pathogenesis normally glands secrete mucus for vaginal/vulvar lubrication if orifice becomes obstructed, mucus accumulates and gland dilates Presentation Symptoms typically painless larger cysts can cause vaginal discomfort especially during sexual intercourse, walking, sitting, and exercise Physical exam unilateral swelling of the labia most prominent in the lower medial labia majora Studies Diagnostic testing diagnostic approach based on clinical history and exam studies culture indicated only if suspicious for infection biopsy indicated if risk factors exist for carcinoma older age palpable solid mass fixation of cyst to surrounding tissue cyst does not respond to treatment Differential Bartholin gland carcinoma painless and solid vulvar mass Treatment First-line conservative symptom management sitz bath warm compress analgesics Second-line incision and drainage, followed by placement of Word catheter indicated if cysts ≥ 3 cm, symptomatic, or disfiguring Complications Bartholin abscess epidemiology risk factors history of sexually transmitted infections (STIs) pathogenesis an obstructed Bartholin duct that becomes infected most commonly polymicrobial, Staphylococcus aureus, or Escherichia coli less than 1/3 associated with STIs presentation symptoms severe vaginal pain and swelling physical exam warm, tender, fluctuant, unilateral mass in the lower medial labia majora may have purulent drainage studies diagnostic approach diagnosis based on clinical history and exam culture treatment first-line incision and drainage, followed by placement of Word catheter second-line antibiotics indicated for severe infection or recurrent abscesses