Review Question - QID 221253

This patient presents with a 3 cm right-sided, soft, nontender, mobile, flesh-colored mass at the 8 o'clock position of the vulva with no fluid drainage. This presentation is consistent with a Bartholin gland cyst, which should be treated with incision and drainage.

Bartholin gland cysts are found in the posterior aspect of the vulva at either the 4 o'clock or 8 o'clock position and are most often caused by blockage of the Bartholin ducts. Bartholin glands secrete vaginal mucus for lubrication, are nonpalpable, and typically have a diameter of 0.5 cm. The blockage of the duct causes a buildup of mucus and the development of a cyst that is typically 1-3 cm in size. Obstruction of the duct can also lead to an abscess. An abscess is typically extremely painful, tender, warm, and fluctuant. The diagnosis of a Bartholin cyst is made clinically. Treatment for Bartholin gland cysts ≥ 3 cm is incision and drainage, followed by Word catheter placement.

Omole et al. review the evidence regarding the diagnosis and treatment of a Bartholin gland cyst. They discuss how the goal of treatment is to preserve the function of these glands when possible. They recommend incision and insertion of a Word catheter for inflamed cysts.

Figure/Illustration A is a clinical photograph demonstrating a mass at the 8 o'clock position of the vaginal introitus (red circle). This appearance is consistent with a right-sided Bartholin gland cyst.

Incorrect Answers:
Answer 1: Acyclovir therapy is used to manage genital herpes simplex. Genital herpes simplex typically presents with painful, burning, clustered vesicles in the genital area, and primary infection may be accompanied by swollen pelvic lymph nodes and flu-like symptoms.

Answer 2: Antibiotics are not beneficial in treating Bartholin gland cysts, as these cysts are most often sterile. Even for patients exhibiting Bartholin gland tenderness, warmth, and fluctuance, suggesting an abscess, antibiotics are not typically used; incision, drainage, and Word catheter placement should resolve the abscess. Antibiotics are reserved for recurrent Bartholin abscesses, patients at high risk for a complicated course, culture-positive MRSA, or signs of systemic infection.

Answer 3: Biopsy is not recommended for Bartholin gland cysts unless the mass is partially solid, immobile, progressing after treatment, or the patient is postmenopausal. If any of these signs are present, the mass has a chance of being malignant, and pathology should be evaluated.

Answer 4: Cryotherapy involves freezing and thawing tissue, most typically to remove genital warts caused by HPV. It is not an appropriate treatment for a Bartholin gland cyst.

Bullet Summary:
Bartholin gland cysts present as a unilateral, nontender, soft, mobile, flesh-colored mass at either the 4 or 8 o'clock position in the posterior aspect of the vulva.