To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses.We searched PubMed, EMBASE, CINAHL, LILACS, Web-of-science, the Cochrane database, and POPLINE from 1982 until May 2008. We searched the internet, hand-searched reference lists, and contacted experts and authors of relevant papers to detect all published and unpublished studies.We included any study with at least 10 participants, addressing either frequency of recurrence or healing time after treatment of Bartholin duct cyst or abscess. We followed MOOSE (meta-analysis of observational studies in epidemiology) guidelines. Of 532 articles identified, 24 studies (5 controlled trials, 2 cohort studies, and 17 case series) met all inclusion criteria. Study size ranged between 14 and 200 patients.The interventions included: (1) Silver nitrate gland ablation, (2) cyst or abscess fenestration, ablation, or excision using carbon dioxide (CO(2)) laser, (3) marsupialization, (4) needle aspiration with or without alcohol sclerotherapy, (5) fistulization using a Word catheter, Foley catheter, or Jacobi ring, (6) gland excision, and (7) incision and drainage followed by primary suture closure. The reported frequency of recurrence varied from 0% to 38%. There was no recurrence after marsupialization in available studies. Recurrence after other treatments varied, and was most common after aspiration alone. Healing generally occurred in 2 weeks or less.There are multiple treatments for Bartholin duct cysts and abscesses. A review of the literature failed to identify a best treatment approach.Obstetricians & Gynecologists, Family PhysiciansAfter completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.

Bartholin's duct cysts and gland abscesses are common problems in women of reproductive age. Bartholin's glands are located bilaterally at the posterior introitus and drain through ducts that empty into the vestibule at approximately the 4 o'clock and 8 o'clock positions. These normally pea-sized glands are palpable only if the duct becomes cystic or a gland abscess develops. The differential diagnosis includes cystic and solid lesions of the vulva, such as epidermal inclusion cyst, Skene's duct cyst, hidradenoma papilliferum, and lipoma. The goal of management is to preserve the gland and its function if possible. Office-based procedures include insertion of a Word catheter for a duct cyst or gland abscess, and marsupialization of a cyst; marsupialization should not be used to treat a gland abscess. Broad-spectrum antibiotic therapy is warranted only when cellulitis is present. Excisional biopsy is reserved for use in ruling out adenocarcinoma in menopausal or perimenopausal women with an irregular, nodular Bartholin's gland mass.

Little is known about the epidemiology of Bartholin's duct abscess and cyst. We did an emergency department-based case-control study to examine demographic risk factors for this condition. We found that risk varied by age. After adjustment for pregnancy status, the relative odds (odds ratio [OR]) of occurrence of Bartholin's duct abscess for women 20 to 29 years old, compared to women younger than 20 years, was 2.3. The association was weaker among women in their 30s and 40s (OR = 1.4 and 1.1, respectively). The majority of patients were Hispanic whites (66% of cases and 79% of control subjects). Risk of Bartholin's duct abscess was greater among non-Hispanic white women (OR = 1.9) and black women (OR = 2.4). At lowest risk of this condition were women with high parity (> or = 4) or high gravidity (> or = 5). These findings suggest that the risk factor profile of this condition is similar to that of most sexually transmitted diseases. The advisability of presumptive antibiotic treatment of these patients and examination and treatment of their sexual partners should be considered.

Seventy-seven patients with a Bartholin's gland duct disorder were treated by incision and marsupialisation. At operation 18% were found to have a cyst and 82% an abscess. N gonorrhoea was isolated from four abscesses and C trachomatis from one. Bacteriological examination of the uterine cervix yielded one further case of N gonorrhoea and four more of C trachomatis. N gonorrhoea and C trachomatis are of limited aetiologic importance as causes of Bartholin's duct abscess. However, bacteriological examination for STD of the abscess and the cervix is mandatory because of adequate antibiotic treatment of the patients and their contacts.