A Bartholin abscess presents with vulvar pain and swelling that has developed over 2-3 days, causing discomfort when walking or sitting. On exam, there is a tender, swollen lump on one or both sides of the posterior labia. Treatment involves antibiotics if mild, or incising and draining the abscess if pointing, then inserting a Word catheter and continuing antibiotics and sitz baths, with follow up in 48 hours. It is important not to mistake a Bartholin cyst or perirectal abscess for a Bartholin abscess, as they require different treatments.

1. Bartholin Abscess
Presentation
A woman complains of vulvar pain and swelling that has developed over the past 2-3
days, making walking and sitting very uncomfortable. On physical exam in the lithotomy
position, there is a unilateral (occasionally bilateral), tender, fluctuant, erythematous
swelling at 5 or 7 o'clock within the posterior labium minus.
What to do:
• If the swelling is mild without fluctuance (bartholinitis) or if the abscess is not
pointing, the patient can be placed on an antibiotic (e.g., ciprofloxacin 500mg
and azithromycin 1000mg po once, ofloxacin or doxycycline 100mg po bid x14d)
and instructed to take warm sitz baths. Early followup should be provided.
• When the abscess is pointing, an incision should be made over the medial
bulging surface and the pus evacuated.
• After drainage a Word catheter should be inserted through the incision. Inflate
the tip of the catheter with sterile water to hold it in place and prevent
premature closure of the opening.
• After drainage, the patient should be placed on antibiotics and instructed to take
sitz baths.
• Provide for a followup exam within 48 hours.
What not to do:
• Do not mistake a nontender Bartholin duct cyst, which does not require
immediate treatment, for an inflamed abscess.
• Do not mistake a more posterior perirectal abscess for a Bartholin abscess. The
perirectal abscess requires a different treat ment approach.

2. Discussion
The most common organisms involved in the development of a Bartholin abscess are
gonococci, streptococci, Escherichia coli, Proteus and Chlamydia, and often more than
one organism is present. Bilateral infections are more commonly characteristic of
gonorrhea. The Word catheter is a 5 mL balloon on a 5 cm catheter designed to retain
itself in the abscess cavity for 4-6 weeks to help insure the development of a wide
marsupialized opening for continued drainage, but they seldom stay in place that long.
Iodoform or plain ribbon gauze can be inserted into the incised abscess as a substitute.
If a wide opening persists, recurrent infections are not likely to occur, but they are
common if the stoma closes.