What is included in emergency department (ED) care of Bartholin gland diseases?

Updated: Aug 10, 2017
  • Author: Antonia Quinn, DO; Chief Editor: Erik D Schraga, MD  more...
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ED care should include a careful history and physical examination. A patient whose presentation is concerning for malignancy should receive close outpatient gynecologic follow-up for biopsy and possible excision. Those with an uncomplicated, asymptomatic cyst may be discharged with sitz bath instructions. Sitz baths (3 times daily) for several days may promote improvement with resolution or spontaneous rupture with resolution of the cyst. [7]

A Bartholin abscess is generally painful, and, thus, usually requires incision and drainage. Several techniques have been described, [14] but no large prospective studies have been performed to determine relative efficacy and complications. The goal of abscess treatment is to allow drainage and to prevent rapid reaccumulation of fluid. These techniques are described below. Refer to the Medscape Reference Clinical Procedures article Bartholin Abscess Drainage for Bartholin cyst management and further details.

Patient comfort is essential to successful drainage. Adequate anesthesia is necessary when incising any abscess. Apply topical anesthetics to the mucosa followed by submucosal injection of local anesthetic (the minimum pain control required). Procedural sedation may be desirable. In patients with a large or complex abscess or for a complicated procedure, general anesthesia in the operating room (OR) may be required.

In a study of patients with Bartholin gland carcinoma, high-dose-rate interstitial brachytherapy (HDR-ISBT) boost after external-beam radiation therapy (EBRT) was shown to provide excellent long-term local control. According to the authors, HDR-ISBT should be considered for positive surgical margins or residual tumor after surgery and for locally advanced malignancies treated by primary chemoradiotherapy. [15]

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