Bartholin's gland | |
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Details | |
Precursor | Urogenital sinus |
Artery | External pudendal artery [1] |
Nerve | Ilioinguinal nerve [1] |
Lymph | Superficial inguinal lymph nodes |
Identifiers | |
Latin | glandula vestibularis major |
MeSH | D001472 |
TA98 | A09.2.01.016 |
TA2 | 3563 |
FMA | 9598 |
Anatomical terminology |
The Bartholin's glands (named after Caspar Bartholin the Younger; also called Bartholin glands or greater vestibular glands) are two pea-sized compound alveolar glands [2] located slightly posterior and to the left and right of the opening of the vagina. [3] They secrete mucus to lubricate the vagina. [3]
They are homologous to bulbourethral glands in males. However, while Bartholin's glands are located in the superficial perineal pouch in females, bulbourethral glands are located in the deep perineal pouch in males. Their duct length is 1.5 to 2.0 cm and they open into navicular fossa. [2] The ducts are paired and they open on the surface of the vulva. [3]
The embryological origin of the Bartholin's glands is derived from the urogenital sinus; therefore, the nerve innervation and blood supply are via the pudendal nerve and external pudendal artery, respectively. The superficial inguinal lymph nodes and pelvic nodes provide lymphatic drainage. [4]
These glands are pea-sized (0.5–1.0 cm) and are lined with columnar epithelium. The duct length is 1.5–2 cm and is lined with squamous epithelium. These are located just beneath the fascia and their ducts drain into the vestibular mucosa. These mucoid alkaline secreting glands are arranged as lobules consisting of alveoli lined by cuboidal or columnar epithelium. Their efferent ducts are composed of transitional epithelium, which merges into squamous epithelium as it enters the distal vagina. The more proximal portions of the ductal system are lined by transitional epithelium and may be lined by columnar epithelium before arborization into glandular secretory elements. [5]
These glands lie on the perineal membrane and beneath the bulbospongiosus muscle at the tail end of the vestibular bulb deep to the posterior labia majora. The intimate relation between the enormously vascular tissue of the vestibular bulb and the Bartholin's glands is responsible for the risk of hemorrhage associated with the removal of this latter structure. [6]
The Bartholin's glands are located on the posterior margin of the introitus bilaterally, opening in a groove between the hymen and the labium minus at the 4:00 and 8:00 o'clock positions. The glands duct opening is seen on the posterolateral aspect of the vestibule 3 to 4 mm outside the hymen or hymenal caruncles lateral to the hymenal ring. [7]
Bartholin's glands were first described in 1677 by the 17th-century Danish anatomist Caspar Bartholin the Younger (1655–1738). [8] [9] Earlier he jointly discovered the glands in cows with Joseph Guichard Duverney (1648-1730), a French anatomist. [10] Some sources mistakenly ascribe their discovery to his grandfather, theologian and anatomist Caspar Bartholin the Elder (1585–1629). [11]
Bartholin's glands secrete mucus to provide vaginal lubrication during sexual arousal. [9] [12] [13] The fluid may slightly moisten the labial opening of the vagina, serving to make contact with this sensitive area more comfortable. [14] Fluid from the Bartholin's glands is combined with other vaginal secretions as a "lubrication fluid" in the amount of about 6 grams per day, and contains high potassium and low sodium concentrations relative to blood plasma, with a slightly acidic pH of 4.7. [15]
It is possible for the Bartholin's glands to become blocked and inflamed resulting in pain. [14] This is known as bartholinitis or a Bartholin's cyst. [9] [16] [17] A Bartholin's cyst in turn can become infected and form an abscess. Adenocarcinoma of the gland is rare and benign tumors and hyperplasia are even more rare. [18] Bartholin gland carcinoma [19] is a rare malignancy that occurs in 1% of vulvar cancers. This may be due to the presence of three different types of epithelial tissue. [8] Inflammation of the Skene's glands and Bartholin glands may appear similar to cystocele. [20]
In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.
In female human anatomy, Skene's glands or the Skene glands are glands located around the lower end of the urethral meatus. The glands are surrounded by tissue that swells with blood during sexual arousal, and secrete a fluid from openings near the urethra, particularly during orgasm.
The bulbourethral glands or Cowper's glands are two small exocrine and accessory glands in the reproductive system of many male mammals. They are homologous to Bartholin's glands in females. The bulbourethral glands are responsible for producing a pre-ejaculate fluid called Cowper's fluid, which is secreted during sexual arousal, neutralizing the acidity of the urethra in preparation for the passage of sperm cells. The paired glands are found adjacent to the urethra just below the prostate, seen best by screening (medicine) MRI as a tool in preventative healthcare in males. Screening MRI may be performed when there is a positive prostate-specific antigen on basic laboratory tests. Prostate cancer is the second-most common cause of cancer-related mortality in males in the USA.
A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.
A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked. Small cysts may result in minimal or no symptoms. Larger cysts may result in swelling on one side of the vaginal opening, as well as pain during sex or walking. If the cyst becomes infected, an abscess can occur, which is typically red and very painful. If there are no symptoms, no treatment is needed. Bartholin's cysts affect about 2% of women at some point in their life. They most commonly occur during childbearing years.
The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.
The vulval vestibule is the part of the vulva between the labia minora. On the inside, the urinary meatus and the vaginal opening open to the vestibule, while the outer edge is marked by Hart's line, named after David Berry Hart.
The urogenital triangle is the anterior part of the perineum. In female mammals, it contains the vagina and associated parts of the internal genitalia.
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used to assess a woman's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the vulva 2) the internal exam with palpation to examine the uterus, ovaries, and structures adjacent to the uterus (adnexae) and 3) the internal exam using a speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.
A vaginal disease is a pathological condition that affects part or all of the vagina.
In mammals, the vulva consists of the external female genitalia. The human vulva includes the mons pubis, labia majora, labia minora, clitoris, vulval vestibule, urinary meatus, vaginal opening, hymen, and Bartholin's and Skene's vestibular glands. The vulva includes the entrance to the vagina, which leads to the uterus, and provides a double layer of protection for this by the folds of the outer and inner labia. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.
Male accessory glands (MAG) in humans are the seminal vesicles, prostate gland, and the bulbourethral glands. In insects, male accessory glands produce products that mix with the sperm to protect and preserve them, including seminal fluid proteins. Some insecticides can induce an increase in the protein content of the male accessory glands of certain types of insects. This has the unintended effect of increasing the number of offspring they produce.
A vulvar disease is a particular abnormal, pathological condition that affects part or all of the vulva. Several pathologies are defined. Some can be prevented by vulvovaginal health maintenance.
Vaginal adenosis is a benign abnormality in the vagina, commonly thought to be caused by intrauterine and neonatal exposure of diethylstilbestrol and other progestogens and nonsteroidal estrogens, however it has also been observed in otherwise healthy women and has been considered at times idiopathic or congenital. Postpubertal lesions have also been observed to grow de novo. It has a rather common incidence, of about 10% of adult women.
A vestibulectomy is a gynecological surgical procedure that can be used to treat vulvar pain, specifically in cases of provoked vestibulodynia. Vestibulodynia is a chronic pain syndrome that is a subtype of localized vulvodynia where chronic pain and irritation is present in the vulval vestibule, which is near the entrance of the vagina. Vestibulectomy may be partial or complete.
The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings. This assessment is the most frequently used among research publications related to pelvic organ prolapse.
Vaginal rugae are structures of the vagina that are transverse ridges formed out of the supporting tissues and vaginal epithelium in females. Some conditions can cause the disappearance of vaginal rugae and are usually associated with childbirth and prolapse of pelvic structures. The rugae contribute to the resiliency and elasticity of the vagina and its ability to distend and return to its previous state. These structures not only allow expansions and an increase in surface area of the vaginal epithelium, they provide the space necessary for the vaginal microbiota. The shape and structure of the rugae are supported and maintained by the lamina propria of the vagina and the anterior and posterior rugae.
Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Some cysts can be distinguished visually but most will need a biopsy to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.
Vulvar tumors are those neoplasms of the vulva. Vulvar and vaginal neoplasms make up a small percentage (3%) of female genital cancers. They can be benign or malignant. Vulvar neoplasms are divided into cystic or solid lesions and other mixed types. Vulvar cancers are those malignant neoplasms that originate from vulvar epithelium, while vulvar sarcomas develop from non-epithelial cells such as bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Epithelial and mesenchymal tissue are the origin of vulvar tumors.