QuestionSBA
QuestionChoice
Cervical cerclage is the placement of a suture into the cervix of a pregnant woman where there is premature shortening of the cervix, with an aim to prolong gestation.
49799
c
Cerclage
QuestionChoice
Hymenectomy is a surgical procedure to open the hymen to allow for the passage of menstrual blood and sexual intercourse. It is often necessary for people born with an imperforate hymen, or who have a septate hymen.
49800
d
Hymenectomy
QuestionChoice
Deinfibulation refers to a surgical procedure to restore the vaginal introitus in women who have undergone type III female genital mutilation (infibulation, or surgical closure/narrowing of the vaginal introitus).
49798
b
Deinfibulation
QuestionChoice
Insertion of a balloon catheter (often referred to as a Word catheter) is one of the preferred management strategies for symptomatic Bartholin's cyst abscess. Under local anaesthesia, a stab incision is made into the labia minora, over the abscess, and the contents of the abscess drained. A balloon catheter is then inserted into the cyst cavity and the balloon inflated with 2-4mL of saline. A suture may be placed to keep the catheter in place. The catheter remains in place for up to 4 weeks to allow epithelialisation of the tract to occur.
49797
a
Insertion of a balloon catheter
QuestionChoice
Vaginal ring pessaries are used for the conservative management of pelvic organ prolapse such as a cystocele or rectocele.
49801
e
Insertion of a vaginal ring pessary
Concept
Chapter
# Summary
  
 
Bartholin's glands are located within the vestibule, lateral to the introitus, and function to secrete a lubricating fluid. A Bartholin's cyst develops when the gland's duct becomes blocked, causing palpable swelling and pain at the gland site. If a cyst becomes infected, it evolves into a Bartholin's gland abscess. Key investigations include physical examination, ultrasound, biopsy, and sometimes culture of the fluid. Management strategies range from conservative treatment like warm salt baths for pain relief, antibiotics in cases of abscess, to more invasive procedures like incision and drainage or other surgical intervention in recurrent cases.
  
 
# Definition
  
 
Bartholin's glands are situated within the vestibule, just lateral to the introitus, and their primary function is to secrete a lubricating fluid. 
Pathologies associated with these glands include:
  
 
  - Bartholin's gland cyst: This occurs when the duct from the gland becomes blocked, resulting in palpable swelling and pain at the site of the Bartholin's gland.
  - Bartholin's gland abscess: This occurs when a cyst becomes infected, resulting in extreme pain, lymphadenopathy, erythema, and in rare cases, systemic upset.
  
 
# Epidemiology
  
 
Bartholin's gland cysts and abscesses are common gynaecological issues. Data suggests that these conditions are most prevalent in women of reproductive age, typically between 20-30 years old.
  

# Aetiology
  
 
The primary cause of Bartholin's gland cysts and abscesses is the blockage of the gland's duct. This blockage can be due to thick mucus, inflammation, trauma, or in rare cases, malignancy. Abscesses are typically caused by infection of a cyst, often with normal vaginal flora or sexually transmitted bacteria.
  
 
# Signs and Symptoms
  
 
  - Bartholin's gland cyst: Palpable swelling and pain at the site of the Bartholin's gland.
  - Bartholin's gland abscess: Extreme pain, lymphadenopathy, erythema, and in rare cases, systemic upset such as fever and malaise.
  
 
# Differential Diagnosis
  
 
  - **Vaginal cysts:** Typically asymptomatic but can cause discomfort during sex or when sitting.
  - **Skene's duct cysts:** Located on either side of the urethra, can cause discomfort during sex or urination.
  - **Vulvar cancer:** Can present with a vulvar lump, itching, pain, or abnormal bleeding.
  
 
# Investigations
  
**Bedside:**

  - Physical examination: To assess the size, location, and nature (cystic or solid) of the swelling.

**Bloods:**

  - Culture: In cases of abscess to identify the causative organism.
  - FBC, CRP: Markers of inflammation . 

 **Invasive:**
 
  - Ultrasound: To confirm the diagnosis and rule out other potential causes of vulvar swelling.
  - Biopsy: In postmenopausal women or in cases where malignancy is suspected.

  
 
# Management

**Conservative:**
 
  - Warm salt water baths: To relieve pain.


**Medical:**
  
  - Antibiotics: Used in cases of abscess to treat the underlying infection.

**Surgical:**
 
  - Incision and drainage: Under local anaesthetic, the swollen gland is incised and allowed to drain. A Word catheter may also be inserted to promote continued drainage.


  
  
# NICE Guidelines
[Click here for NICE guidelines](https://www.nice.org.uk/guidance/ipg323)
1005
1064
Bartholin’s gland
Topic
26
Gynaecology
Video
Concept
1064
Bartholin’s gland
406
QAQSGSE
images/videos/gynecology.png
Vulval cancer
9996
A 23-year-old woman attends the emergency gynaecology clinic having been referred by her general practitioner with vulval pain. On examination, there is a 1.5cm fluctuant swelling at the medial aspect of her right labia minora near
the vaginal introitus which is exquisitely tender. She has palpable superficial inguinal lymphadenopathy. There is no evidence of vaginal discharge, and the woman denies unprotected intercourse.

What is the most appropriate procedural management?
a