Female - Greater Vestibular (Bartholin's) Glands

1. Overview

The greater vestibular glands, commonly known as Bartholin’s glands, are a pair of small, pea-sized exocrine glands located in the female external genitalia. These glands play an essential role in female sexual health by secreting mucus that lubricates the vulvar vestibule during sexual arousal. Though typically inconspicuous and inactive most of the time, their dysfunction can lead to several clinical conditions.

2. Location

Bartholin’s glands are located in the posterior portion of the vestibule of the vulva, specifically within the superficial perineal pouch. Each gland lies just beneath the skin on either side of the vaginal opening, near the base of the labia majora, at approximately the 4 o’clock and 8 o’clock positions. Their ducts open into the vestibule between the hymen and the labia minora.

3. Structure

Each Bartholin's gland is approximately 0.5 to 1.0 cm in size and is composed of:

• Secretory acini: These are clusters of mucus-secreting columnar epithelial cells that produce lubricating fluid.

• Duct system: Each gland is connected to the vestibular surface by a 1.5–2 cm long duct that opens into a groove between the hymen and the labia minora.

• Connective tissue capsule: The gland is surrounded by connective tissue and is embedded in the superficial fascia of the perineum.

These glands are homologous to the bulbourethral (Cowper's) glands in males and share a similar embryological origin.

4. Function

The primary function of the greater vestibular (Bartholin's) glands is:

• Secretion of a clear, mucoid fluid that lubricates the vestibular area of the vulva, particularly during sexual arousal

• Reduction of friction during sexual intercourse, enhancing comfort and facilitating penetration

• Maintaining moisture of the vulvar tissues during periods of arousal

5. Physiological Role(s)

The Bartholin’s glands are functional primarily during sexual arousal:

• Sexual arousal: Parasympathetic stimulation leads to increased mucus secretion, which moistens the vestibule and vaginal opening.

• Protection: The secretions help maintain a protective moist barrier in the vulvar region, which may aid in reducing microtrauma and bacterial invasion.

• Hormonal regulation: The activity of the glands is influenced by estrogen levels, making them more active during the reproductive years and less so after menopause.

Normally, the glands are non-palpable and asymptomatic unless they become obstructed or infected.

6. Clinical Significance

Despite their small size, Bartholin’s glands can give rise to several clinically relevant conditions:

• Bartholin’s Cyst: Occurs when the duct becomes blocked, leading to fluid accumulation and painless swelling. Most cysts are small and asymptomatic but may grow over time.

• Bartholin’s Abscess: Infection of the cyst can result in a painful abscess, often caused by organisms like Escherichia coli, Staphylococcus aureus, or sexually transmitted infections such as Neisseria gonorrhoeae and Chlamydia trachomatis.

• Recurrent Infections: Some women experience recurrent Bartholin’s abscesses, requiring long-term management or surgical intervention.

• Bartholin’s Gland Carcinoma: A rare malignancy, usually affecting postmenopausal women, presenting as a persistent mass. Biopsy is essential for diagnosis.

• Treatment Options: Management may include warm compresses, incision and drainage, Word catheter placement, marsupialization, or surgical excision in refractory or suspicious cases.

Regular gynecologic examinations help detect Bartholin’s gland abnormalities early. Women with recurrent or persistent glandular issues should be evaluated for possible underlying infection or, rarely, malignancy.