How to diagnose a Bartholin gland abscess

There is a Bartholin gland on each side of the inferior opening of the vagina. These glands secrete lubrication through ducts that exit at the vaginal opening and drain into the vagina.

If one of these ducts becomes obstructed, this can lead to an infection of the gland. Bartholin gland abscesses occur in approximately 2% of women during their reproductive years. The cause is currently unknown.

There are two main indications for draining a Bartholin gland abscess:

1. Halting the progression of infection and preventing sepsis
2. Relieving pain

There are several situations where you shouldn’t drain a suspected peritonsillar abscess:

1. Uncertain diagnosis
2. Other masses present
3. Abscess is too large
4. Patient is too sensitive for bedside procedure (patient needs sedation or moved to an operating room)
5. Coagulopathy
6. Severe thrombocytopenia

Potential complications of the procedure include bleeding, risk of worsening infection (especially if the patient is immunocompromised), and pain during local anesthesia.

Physical signs of a Bartholin gland abscess

There are three main physical signs of a Bartholin gland abscess:

1. Unilateral external vaginal pain
2. Subtle or very large swelling that worsens when walking
3. Tender, erythematous (red) area of fluctuance (like a balloon filled with fluid) at the vaginal opening

The treatment for this abscess is incision and drainage. If there are no contraindications to using this technique on your patient it can be done in the emergency room (ER) or the office. Follow up with a gynecologist is necessary. Sometimes, the abscess can recur and the gynecologist can perform a surgical procedure to prevent future recurrence.

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