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Basics

[Section Outline]

Author:

Steven P.Gohsler


Description!!navigator!!

Epidemiology!!navigator!!

Prevalence

Most common in women aged 20-30 yr of age

Etiology!!navigator!!

Risk Factors!!navigator!!

Diagnosis

[Section Outline]

Signs and Symptoms!!navigator!!

History

Acute onset:

  • Painful, unilateral labial swelling
  • Pain with sitting, walking and limitation of physical activity
  • Dyspareunia

Physical Exam

  • Bartholin abscess:
    • Tender, fluctuant, unilateral labial mass
    • Vulva asymmetry
    • Vaginal discharge
    • Cellulitis may be present with surrounding erythema and edema
    • Fever is uncommon
  • Bartholin cyst:
    • Painless, unilateral labial mass

Essential Workup!!navigator!!

Diagnosis based on findings of tender, localized, fluctuant mass in region of Bartholin gland

Diagnostic Tests & Interpretation!!navigator!!

Lab

  • Routine culture of material from abscess to include testing for gonorrhea and chlamydia
  • Culture cervix for gonorrhea and chlamydia

Imaging

Generally not indicated, although ultrasound may provide confirmatory evidence

Differential Diagnosis!!navigator!!

Treatment

[Section Outline]

ED Treatment/Procedures!!navigator!!

Medication!!navigator!!

First Line

Broad-spectrum coverage:

Second Line

Treat for STD if indicated

Follow-Up

[Section Outline]

Disposition!!navigator!!

Admission Criteria

  • Sepsis
  • Significant cellulitis
  • Evidence of necrotizing infection

Discharge Criteria

Well-appearing patients may be discharged with designated follow-up plan

Issues for Referral

Patients should have gynecologic follow-up:

  • Follow-up in 24-48 hr for removal of packing
  • Follow-up in 2-4 d after insertion of Word catheter

Follow-up Recommendations!!navigator!!

Continue sitz baths for at least 72 hr

Pearls and Pitfalls

  • Do not mistake a nontender Bartholin cyst, which does not require immediate treatment, for an inflamed abscess
  • Consider malignancy as an alternative cause of a mass, particularly in women >40 yr
  • Incision should be on mucosal surface of abscess

Additional Reading

See Also (Topic, Algorithm, Electronic Media Element)

Codes

ICD9

ICD10

SNOMED