Bartholin Gland

What is the Bartholin gland?

The Bartholin gland (greater vestibular gland) is a paired, mucus-secreting gland located posterolaterally in the vulvar vestibule, classically near the 4 o’clock and 8 o’clock positions of the vaginal introitus in reproductive-age individuals. It contributes to vestibular lubrication, supporting the local mucosa. Each gland is typically 0.5–1 cm in size and drains through a duct approximately 1.5–2 cm long that opens into the vestibule just lateral to the hymenal ring.

What is the structure of the Bartholin gland?

Each Bartholin gland contains secretory acini lined by mucin-producing columnar epithelium that drain into a short excretory duct. The gland sits within fibrous stroma deep to the posterior labia minora. When the duct becomes obstructed (e.g., by inflammation or thickened secretions), retained mucus dilates the ductal system and can form a Bartholin gland cyst. If microorganisms infect an obstructed duct or cyst, the collection can evolve into an abscess, typically with increasing inflammation and pain.

What is the neurovascular supply of the Bartholin gland?

The Bartholin gland receives arterial supply from branches of the internal pudendal artery, including the perineal branch, with venous drainage paralleling arterial pathways to the internal pudendal venous system. Sensory innervation arises primarily from the pudendal nerve via perineal branches, which explains the marked pain that can accompany acute distension or inflammation. Procedures in this region can be painful and vascular; use adequate local anesthesia and careful technique to reduce bleeding risk and avoid unnecessary tissue trauma.

What is the clinical significance of the Bartholin gland?

Duct obstruction can present as a Bartholin gland cyst, usually as a unilateral, fluctuant mass near the posterior introitus. Infection of a cyst or duct can cause bartholinitis and may progress to a Bartholin abscess, characterized by localized tenderness, erythema, swelling, and functional limitation (e.g., pain with walking or sitting). In patients ≥40 years or postmenopausal, a new Bartholin-region mass should prompt evaluation for malignancy rather than being presumed benign. Asymptomatic cysts can be managed conservatively (e.g., sitz baths/observation), while symptomatic cysts or abscesses typically require drainage. Marsupialization is considered for recurrent disease or selected cases. Clinicians typically reserve antibiotics for situations such as surrounding cellulitis, systemic features, or higher-risk immune status, rather than using them routinely after drainage.

What are the most important facts to know about the Bartholin gland?

• The Bartholin glands are paired vestibular glands near the posterior introitus that contribute to lubrication.
• Duct obstruction can produce a Bartholin gland cyst, and secondary infection can convert a cyst into an abscess.
• Internal pudendal vascular supply and pudendal sensory innervation help explain the severity of pain and risk of bleeding during procedures.
• First-line management emphasizes drainage. Marsupialization is considered for recurrence, and antibiotics are used selectively based on clinical features.