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The Bartholin’s glands were first described by Caspar Bartholin, a Dutch anatomist in 1677. They develop from buds in the epithelium of the posterior area of the vestibule, and function as secretory glands for the vulva.
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 The glands are located bilaterally at the base of the labia minora at approximately the 4 o’clock and 8 o’clock positions. Each gland is about 0.5cm in size and drains into a duct approximately 2.5cm long. 7,15,20 The glands contain acini composed of simple, columnar, mucous- secreting epithelium. The ducts are lined proximally with mucous- secreting epithelium and distally by transitional epithelium. 10 The ducts emerge onto the vestibule, one at each side of the vaginal orifice, just external to the hymenal ring between the hymen and labia minora where the duct lining becomes squamous epithelium. 20 Thus, Bartholin gland cancer can be a squamous, transitional cell or adenocarcinoma. 10,14 The blood supply is from the artery of the bulb (vestibular bulbs located beneath the glands) which is branch of the artery of the clitoris from the internal pudendal artery. 14
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 The Bartholin’s glands secrete mucous to provide moisture for the vulva; they are homologues of the bulbourethral glands (Cowper’s glands) in males. 20 Although the gland’s secretions provide moisture for the vulva, they are not needed for sexual lubrication as removal of a Bartholin gland does not seem to compromise vaginal lubrication or sexual function. 7,20 These glands are usually non-palpable unless the duct becomes cystic, or a gland abscess develops. 20 The Bartholin’s glands typically shrink during menopause. 22 Disorders of the Bartholin’s gland include duct cysts, gland abscesses and rare carcinoma. 15,20 Chronic inflammation can obstruct the orifice of the Bartholin’s gland duct. This leads to accumulation of secretions and cystic dilatation of the duct, but not the gland, proximal to the obstruction. Cysts are usually sterile collections. 10,20 Bartholin’s duct cysts are usually located at the posterior introitus in the region of the duct opening into the vestibule. Larger cysts can protrude medially, obscuring the normal introital opening. Occasionally cysts will dissect anteriorally within the body of the labium majus and laterally into the subcutaneous fat lateral to the introitus. 22
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Abscesses result from superinfection of the cysts with formation of a rapidly enlarging, painful, inflammatory mass. 2,22 Historically, Bartholin gland abscesses were thought to develop mainly from gonoccocal or chlamydial infections. 7,20,22 However, cultures from Bartholin’s gland abscesses are typically polymicrobial and contain a broad range of bacteria similar to the natural flora of the vagina. 1,3,4,19.20,24 Studies have shown that although Neisseria Gonorrhea is the predominant aerobic isolate, 23 anaerobes are the most common pathogens isolated. 3,4,22 Other aerobic organisms cultured are Staph aureus, strep faecalis, E.Coli, Pseudomonas aeruginosa and chlamydia trachomatis. The most common anaerobic bacteria cultured were Bacteroides species. Other anerobic isolates included Clostridium perfringens, Peptostreptococcus species and fusobacterium species. 1,4,22,24 The most serious sequela of infection is a polymicrobial, necrotizing subcutaneous infection, especially in diabetic women. 20 |
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