0071643192.pdf

OBSTETRICS AND GYNECOLOGY

TREATMENT

Management of the amenorrheic patient depends on the individual’s desire to
ovulate and the etiology of the amenorrhea.

BARTHOLIN ABSCESS

■ Bartholin glands are located bilaterally at the posterior introitus and drain
through ducts into the vestibule at approximately the 4 o’clock and 8 o’clock
positions.
■ Normally pea-sized glands are palpable if the duct becomes cystic or a
gland abscess develops.
■ Obstruction of the duct results in retention of the secretions and cystic
dilation.

SYMPTOMS/EXAM

■ Pain, tenderness, and dyspareunia are acute symptoms.
■ Surrounding tissue becomes edematous and inflamed.
■ A tender, fluctuant mass is usually palpable.

TREATMENT

■ Primary treatment consists of drainage of the infected cyst/abscess followed
by insertion of a word catheter or marsupialization.
■ The word catheter is a small inflatable bulb-tipped catheter that allows for
drainage.
■ Incision and drainage alone without use of the word catheter to keep the
wound open is associated with recurrent disease.
■ Broad-spectrum antibiotic therapy is warranted only when cellulitis is
present.

TABLE 12.7. Causes of Primary Amenorrhea with Normal Genital Exam

UTERUSPRESENT UTERUSABSENT

Breast development Hypothalamic Congenital (uterovaginal

present agenesis)

Pituitary Androgen insensitivity

(testicular feminization)

Ovarian

Uterine

Breast development Gonadal failure 17,20-Desmolase deficiency

absent Agonadism

CNS (hypothalamic, 17-Hydroxylase deficiency

pituitary disorders) (46,XY)