17-year-old girl presents
with a vulval swelling. She noticed a lump a few weeks
earlier and in the
last 2 days
it has enlarged and become painful. She cannot walk
normally and has
not been able
to wear her
normal jeans because
of the discomfort. She feels well
in her- self however.
has been sexually
active since the age of 14 years and uses the depot progesterone
injection for contraception and therefore
does not have periods. She has been with her boyfriend for 8 months and on direct questioning reports unprotected intercourse with two other boys in that time. She had a sexual health
screen in a genitourinary clinic
1 year ago and
the result was
normal. There is no other
medical history of note and
she takes no medication.
temperature is 37.7°C,
heart rate 68/min and blood pressure normal.
Abdominal examination is normal.
There is a left-sided posterior labial swelling extending anteriorly from the level
of the introitus, measuring 6 × 4 × 4 cm. It appears red, fluctuant, tense and is exquisitely tender
to touch. Bilateral tender inguinal lymph
nodes are noted.
What is the diagnosis?
How would you manage this patient?
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.
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.
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
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