- Email: [email protected]
Incidence of Bartholin duct cysts and abscesses in the Republic of Korea
International Journal of Gynecology and Obstetrics 122 (2013) 62–64
Contents lists available at SciVerse ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
CLINICAL ARTICLE
Incidence of Bartholin duct cysts and abscesses in the Republic of Korea Jin-Sung Yuk a, Yong-Jin Kim b, Jun-Young Hur b, Jung-Ho Shin b,⁎ a b
Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Republic of Korea Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
a r t i c l e
i n f o
Article history: Received 26 November 2012 Received in revised form 1 February 2013 Accepted 6 March 2013 Keywords: Age Bartholin duct abscess Bartholin duct cyst Incidence
a b s t r a c t Objective: To estimate the incidence of Bartholin duct cysts and abscesses in the Republic of Korea during 2009. Methods: A national patient sample (n = 599 186) was obtained from Korean Health Insurance Review and Assessment Service data and analyzed to estimate the incidence of Bartholin duct cysts and abscesses among Korean women in 2009. Results: There were 587 Bartholin duct cysts and 757 Bartholin duct abscesses during 2009. The total incidence of Bartholin duct cysts and abscesses was 0.55 per 1000 person-years and 0.95 per 1000 person-years, respectively. In women aged 35–50 years, the incidence was 1.21 per 1000 person-years and 1.87 per 1000 person-years, respectively. In multivariate logistic regression analysis, the incidence of Bartholin duct cysts and abscesses was associated with age (P b 0.01), but not with season or socioeconomic status, among women aged 15–50 years. The main operation performed was marsupialization (45.2%) for Bartholin duct cysts and incision (71.5%) for Bartholin duct abscesses. Conclusion: The incidence of Bartholin duct cysts and abscesses increased with age until menopause, decreasing thereafter. © 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.
1. Introduction The Bartholin glands are located left-posterior and right-posterior to the opening of the vagina. The openings of the ducts are at the 4 and 8 o’clock positions on each side of the hymenal ring. Mucus secreted by the Bartholin glands serves as lubrication during intercourse and keeps the vulval area moist. Each Bartholin duct is 1.5–2 cm in length, and if it is plugged a cystic mass is formed—called a Bartholin duct cyst. If an infection forms in the cyst, it is called a Bartholin duct abscess [1,2]. Common microorganisms causing Bartholin duct abscesses are the aerobic and anaerobic organisms that comprise normal vaginal and cervical flora [3]. Some studies have reported that Bartholin duct cysts and abscesses account for as much as 2% of all gynecologic visits per year; however, this estimate is based on incomplete data and its origin is difficult to determine [1,4]. Relatively little is known about the incidence of and the risk factors for Bartholin duct cysts and abscesses [4]. The aim of the present study was to estimate the incidence of and the risk factors for Bartholin duct cysts and abscesses among women in the Republic of Korea in 2009. 2. Materials and methods Everybody in the Republic of Korea is required by law to enroll with the National Health Insurance Service (NHIS) [5]. All medical ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Republic of Korea. Tel.: +82 2 2626 3144; fax: +82 2 838 1560. E-mail address: [email protected] (J.-H. Shin).
institutions in the Republic of Korea ask the NHIS to pay for medical fees, with the exception of some procedures such as cosmetic surgery. The Korean Health Insurance Review and Assessment Service (HIRA) is responsible for reviewing all medical fees sponsored by the NHIS [6]. Thus, the data processed by HIRA include almost all general diseases in the Republic of Korea and could be considered representative of diseases among the national population. Data for 2009 from the National Patients Sample derived from HIRA (HIRA-NPS; serial number HIRA-NPS-2009-0066) were analyzed. HIRA reported that comparisons between HIRA-NPS and the national population are valid [7]. The majority of data (99.9%) was processed electronically, not on paper. HIRA-NPS used a stratified randomsampling method based on gender and age (in 5-year increments) from all patients (in- and out-patient) visiting healthcare institutions during 2009 (45 969 893 people in total). The total sample size of HIRA-NPS was 1 116 040; the in-patient sample (patients who were admitted to a hospital at least once in 2009) included 404 583 people (13% of all in-patients) and the outpatient sample (patients who visited an outpatient department at least once but were not admitted in 2009) included 711 457 people (1% of all outpatients). The dataset included primary diagnosis, secondary diagnosis, surgery or medical therapy, mortality status, location of care (in- or out-patient), type of insurance, medical expenses, operation name, and prescription. The Institutional Review Board of Korea University Guro Hospital, Seoul, approved the study (reference number KUGH12133). All patients in the database were assigned an anonymous ID created by HIRA. The study sample was first filtered for women aged 0–80 years. To estimate the total number of patients with diseases of the Bartholin gland, the Korean Standard Classification of Diseases—which is modified from the International Statistical Classification of Diseases and
0020-7292/$ – see front matter © 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. http://dx.doi.org/10.1016/j.ijgo.2013.02.014
J.-S. Yuk et al. / International Journal of Gynecology and Obstetrics 122 (2013) 62–64
Related Health Problems, 5th revision codes, and the Health Insurance Medical Care Expenses codes (2012 version)—was used. To be counted as involving Bartholin gland-related disease, records had to include 1 of the following diagnosis codes in the HIRA-NPS data: N750 Cyst of Bartholin’s gland; N751 Abscess of Bartholin’s gland; N758 Bartholinitis; or N759 Disease of Bartholin’s gland, unspecified. Additionally, to be counted as involving a procedure relating to the Bartholin glands, records had to include a relevant procedure code: R4050 Incision & Drainage; R4060 Excision; or R4065 Marsupialization. All cases were defined as having received medical treatment, except those involving surgery. If a patient was given the same diagnosis code more than 60 days later, this was assumed to represent a different episode. Low socioeconomic status was defined as NHIS type 1 or type 2 by the Korean Medical Care Act, which is similar to Medicaid in the USA. The seasons were defined as follows: spring included March–May; summer included June–August; fall included September–November; and winter included December–February. SAS Enterprise Guide version 4.3 (SAS Institute, Cary, NC, USA) was used for data analysis. R version 2.15.1 (R Foundation, Vienna, Austria) was used for all statistical analyses and for weighted analyses. All statistical tests were 2-tailed, and results were considered significant if P b 0.05. The χ 2 test for proportions was used to compare sample proportions. Multivariate logistic regression analysis was applied to evaluate risk factors for Bartholin diseases. 3. Results The sample for 2009 included records of 599 186 female patients from a total sample of 1 116 040 individuals. Mean patient age was 38.1 ± 0.0 years. The number of Bartholin duct cysts in the sample was 587; the number of Bartholin duct abscesses was 757. The incidence of Bartholin duct cysts was 0.55 ± 0.04 per 1000 person-years, and the incidence of Bartholin duct abscesses was 0.95 ± 0.06 per 1000 person-years (Table 1). Among women aged 15–50 years, the incidence of Bartholin duct cysts or abscesses was 2.24 ± 0.12 per 1000 person-years. The incidence of Bartholin duct cysts or abscesses across age groups is shown in Fig. 1. In the logistic regression models, age was associated with Bartholin duct cysts and abscesses in women aged 15–50 years, after adjusting for socioeconomic status and seasonal factors (P b 0.01). Of the patients included in the sample, 59.1% (95% confidence interval [CI], 56.7–61.5) with Bartholin duct cysts or abscesses were treated with surgery, while 40.9% (95% CI, 38.5–43.3) were treated medically. The most common operation was incision and drainage (53.6% [95% CI, 45.3–61.9]), followed by marsupialization (32.4% [95% CI, 24.4–40.4]) and removal of Bartholin duct cyst (13.9% [95% CI, 9.5–18.3]). Table 2 summarizes the operations used for treatment of Bartholin duct cysts and abscesses. Of the patients reviewed, 16.8% (95% CI, 15.0–18.6) had Bartholin duct cysts or abscesses more than twice during 2009; 44.2% (95% CI,
63
Fig. 1. Incidence of Bartholin gland disease by 5-year age intervals. Vertical broken line denotes mean age at menopause in the Republic of Korea.
38.5–49.9) of these women underwent surgical treatment. The monthly proportions of Bartholin duct cysts and abscesses are shown in Fig. 2. 4. Discussion The incidence of Bartholin duct cysts in the present study was 0.55 ± 0.04 per 1000 person-years, and that of Bartholin duct abscesses was 0.95 ± 0.06 per 1000 person-years. When only women aged 15–50 years were included, the incidences were higher than for women of all ages. The incidence of Bartholin duct cysts or abscesses among women aged 15–50 years increased with age until late 40s, when it decreased sharply. According to the Korea National Health and Nutrition Examination Survey 2010 [8], the mean age of Korean women at menopause is 48.6 ± 0.2 years. Notably, this age corresponds to that at which the incidence of Bartholin duct cysts and abscesses sharply decreased in the present sample. The mechanism of this relationship is unknown, but several explanations may account for this observation. It may be that there is an increased tendency at younger ages for the Bartholin ducts to plug because the viscosity of the vaginal fluid and Bartholin gland mucus is higher. Inflammation or trauma can cause trigger points to plug the ducts of the Bartholin glands completely. After menopause, however, the total amount of vaginal fluid and Bartholin gland mucus may decrease; a smaller fluid volume means that there is less chance to plug the Bartholin ducts. Hypoestrogenism associated with aging could also lead to decreased fluid transport and decreased lubrication of the lower genital tract [9]. It has also been reported that hypoestrogenism due to menopause could result in atrophy of the urogenital area [10]. We hypothesized a seasonal relationship in the incidence of Bartholin gland pathologies and an association with socioeconomic status. The Republic of Korea has 4 distinct seasons, and substantial variation in temperature is a feature of the Korean climate. We Table 2 Operation type for Bartholin gland disease.a
Table 1 Incidence of Bartholin gland disease.a
Any Bartholin gland diseaseb Cysts or abscesses Cysts Abscesses Bartholinitis Bartholin gland disease, unspecified a b
Operation type Mean age, y
Incidence, per 1000 person-years
All ages
All ages
15–50 y
39.5 39.5 40.3 39.2 38.9 40.6
1.52 1.44 0.55 0.95 0.05 0.03
2.35 2.24 0.85 1.47 0.08 0.04
Values are expressed as mean ± SEM. Excluding cancer.
± ± ± ± ± ±
05 0.5 0.8 0.7 2.8 3.8
± ± ± ± ± ±
0.07 0.07 0.04 0.06 0.02 0.01
± ± ± ± ± ±
0.12 0.12 0.07 0.10 0.02 0.02
Estimated No. of cases Percentage (95% confidence interval)
Cysts or abscesses Incision 10308 ± 889 Excision 4015 ± 490 Marsupialization 5892 ± 637 Cysts Incision 808 ± 246 Excision 3177 ± 428 Marsupialization 3292 ± 479 Abscesses Incision 9831 ± 845 Excision 1000 ± 230 Marsupialization 2923 ± 443 a
51.0 (47.9–54.1) 19.9 (17.6–22.2) 29.2 (26.4–32) 11.1 (7.9–14.3) 43.7 (38.9–48.5) 45.2 (40.3–50.1) 71.5 (68.2–74.8) 7.3 (5.7–8.9) 21.3 (18.3–24.3)
Values are given as mean ± SEM unless otherwise indicated.
64
J.-S. Yuk et al. / International Journal of Gynecology and Obstetrics 122 (2013) 62–64
The present study had limitations. Diagnosis of Bartholin diseases was not confirmed by biopsy or culture, but was considered confirmed by diagnosis code. This may, therefore, reflect clinical incidence rather than true incidence. In summary, the incidence of Bartholin duct cysts and abscesses among women in the Republic of Korea increased with age until menopause, decreasing sharply thereafter. Conflict of interest The authors have no conflicts of interest.
Fig. 2. Monthly trends in Bartholin gland diseases.
hypothesized that massive changes in temperature could influence the moisture environment of the vulval area, which could lead to a change in the incidence of Bartholin duct cysts and abscesses. Different hygiene practices according to socioeconomic status could also influence the incidence of Bartholin duct cysts and abscesses. However, these hypotheses were wrong. On multivariate logistic regression analysis, age was the only risk factor identified, while other factors such as season and socioeconomic status did not significantly predict disease. This area may require further study. If a record showed the same diagnosis code more than 60 days later, it was assumed to represent a separate episode. In the dataset, 16.8% (95% CI, 15.0–18.6) of women with Bartholin duct cysts or abscesses experienced Bartholin diseases more than twice. These cases included both recurrent ipsilateral disease and new contralateral disease. However, these situations were not distinguished in the present data, and the real recurrence rate may be lower than that presented. However, the data were consistent with the results of another study in which the recurrence rate was reported to be less than 20% [4].
References [1] Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis 2004;8(3):195–204. [2] Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010. [3] Brook I. Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol 2002;15(4):217–26. [4] Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv 2009;64(6):395–404. [5] National Health Insurance Service. The Health Insurance System. http://www.nhic. or.kr/static/html/wbd/g/a/wbdga0101.html. Published 2012. Accessed October 18, 2012. [6] Health Insurance Review and Assessment Service. http://www.hira.or.kr/eng/. Published 2012. Accessed October 18, 2012. [7] Health Insurance Review and Assessment Service. Introduction to HIRA-NPS. https:// www.dropbox.com/sh/gj8quoh6w40pgpl/-g5dis7ybd/Introduction%20to%20HIRA_ NPS.pdf. Published 2012. Accessed October 18, 2012. [8] Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare. Korea National Health and Nutrition Examination Survey. http://knhanes.cdc.go. kr/. Accessed August 27, 2012. [9] Gorodeski GI. Aging and estrogen effects on transcervical-transvaginal epithelial permeability. J Clin Endocrinol Metab 2005;90(1):345–51. [10] Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Juliá MD. Management of postmenopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005;52(Suppl. 1): S46–52.
Contents lists available at SciVerse ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
CLINICAL ARTICLE
Incidence of Bartholin duct cysts and abscesses in the Republic of Korea Jin-Sung Yuk a, Yong-Jin Kim b, Jun-Young Hur b, Jung-Ho Shin b,⁎ a b
Department of Obstetrics and Gynecology, MizMedi Hospital, Seoul, Republic of Korea Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
a r t i c l e
i n f o
Article history: Received 26 November 2012 Received in revised form 1 February 2013 Accepted 6 March 2013 Keywords: Age Bartholin duct abscess Bartholin duct cyst Incidence
a b s t r a c t Objective: To estimate the incidence of Bartholin duct cysts and abscesses in the Republic of Korea during 2009. Methods: A national patient sample (n = 599 186) was obtained from Korean Health Insurance Review and Assessment Service data and analyzed to estimate the incidence of Bartholin duct cysts and abscesses among Korean women in 2009. Results: There were 587 Bartholin duct cysts and 757 Bartholin duct abscesses during 2009. The total incidence of Bartholin duct cysts and abscesses was 0.55 per 1000 person-years and 0.95 per 1000 person-years, respectively. In women aged 35–50 years, the incidence was 1.21 per 1000 person-years and 1.87 per 1000 person-years, respectively. In multivariate logistic regression analysis, the incidence of Bartholin duct cysts and abscesses was associated with age (P b 0.01), but not with season or socioeconomic status, among women aged 15–50 years. The main operation performed was marsupialization (45.2%) for Bartholin duct cysts and incision (71.5%) for Bartholin duct abscesses. Conclusion: The incidence of Bartholin duct cysts and abscesses increased with age until menopause, decreasing thereafter. © 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.
1. Introduction The Bartholin glands are located left-posterior and right-posterior to the opening of the vagina. The openings of the ducts are at the 4 and 8 o’clock positions on each side of the hymenal ring. Mucus secreted by the Bartholin glands serves as lubrication during intercourse and keeps the vulval area moist. Each Bartholin duct is 1.5–2 cm in length, and if it is plugged a cystic mass is formed—called a Bartholin duct cyst. If an infection forms in the cyst, it is called a Bartholin duct abscess [1,2]. Common microorganisms causing Bartholin duct abscesses are the aerobic and anaerobic organisms that comprise normal vaginal and cervical flora [3]. Some studies have reported that Bartholin duct cysts and abscesses account for as much as 2% of all gynecologic visits per year; however, this estimate is based on incomplete data and its origin is difficult to determine [1,4]. Relatively little is known about the incidence of and the risk factors for Bartholin duct cysts and abscesses [4]. The aim of the present study was to estimate the incidence of and the risk factors for Bartholin duct cysts and abscesses among women in the Republic of Korea in 2009. 2. Materials and methods Everybody in the Republic of Korea is required by law to enroll with the National Health Insurance Service (NHIS) [5]. All medical ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 80 Guro-dong, Guro-gu, Seoul 152-703, Republic of Korea. Tel.: +82 2 2626 3144; fax: +82 2 838 1560. E-mail address: [email protected] (J.-H. Shin).
institutions in the Republic of Korea ask the NHIS to pay for medical fees, with the exception of some procedures such as cosmetic surgery. The Korean Health Insurance Review and Assessment Service (HIRA) is responsible for reviewing all medical fees sponsored by the NHIS [6]. Thus, the data processed by HIRA include almost all general diseases in the Republic of Korea and could be considered representative of diseases among the national population. Data for 2009 from the National Patients Sample derived from HIRA (HIRA-NPS; serial number HIRA-NPS-2009-0066) were analyzed. HIRA reported that comparisons between HIRA-NPS and the national population are valid [7]. The majority of data (99.9%) was processed electronically, not on paper. HIRA-NPS used a stratified randomsampling method based on gender and age (in 5-year increments) from all patients (in- and out-patient) visiting healthcare institutions during 2009 (45 969 893 people in total). The total sample size of HIRA-NPS was 1 116 040; the in-patient sample (patients who were admitted to a hospital at least once in 2009) included 404 583 people (13% of all in-patients) and the outpatient sample (patients who visited an outpatient department at least once but were not admitted in 2009) included 711 457 people (1% of all outpatients). The dataset included primary diagnosis, secondary diagnosis, surgery or medical therapy, mortality status, location of care (in- or out-patient), type of insurance, medical expenses, operation name, and prescription. The Institutional Review Board of Korea University Guro Hospital, Seoul, approved the study (reference number KUGH12133). All patients in the database were assigned an anonymous ID created by HIRA. The study sample was first filtered for women aged 0–80 years. To estimate the total number of patients with diseases of the Bartholin gland, the Korean Standard Classification of Diseases—which is modified from the International Statistical Classification of Diseases and
0020-7292/$ – see front matter © 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics. http://dx.doi.org/10.1016/j.ijgo.2013.02.014
J.-S. Yuk et al. / International Journal of Gynecology and Obstetrics 122 (2013) 62–64
Related Health Problems, 5th revision codes, and the Health Insurance Medical Care Expenses codes (2012 version)—was used. To be counted as involving Bartholin gland-related disease, records had to include 1 of the following diagnosis codes in the HIRA-NPS data: N750 Cyst of Bartholin’s gland; N751 Abscess of Bartholin’s gland; N758 Bartholinitis; or N759 Disease of Bartholin’s gland, unspecified. Additionally, to be counted as involving a procedure relating to the Bartholin glands, records had to include a relevant procedure code: R4050 Incision & Drainage; R4060 Excision; or R4065 Marsupialization. All cases were defined as having received medical treatment, except those involving surgery. If a patient was given the same diagnosis code more than 60 days later, this was assumed to represent a different episode. Low socioeconomic status was defined as NHIS type 1 or type 2 by the Korean Medical Care Act, which is similar to Medicaid in the USA. The seasons were defined as follows: spring included March–May; summer included June–August; fall included September–November; and winter included December–February. SAS Enterprise Guide version 4.3 (SAS Institute, Cary, NC, USA) was used for data analysis. R version 2.15.1 (R Foundation, Vienna, Austria) was used for all statistical analyses and for weighted analyses. All statistical tests were 2-tailed, and results were considered significant if P b 0.05. The χ 2 test for proportions was used to compare sample proportions. Multivariate logistic regression analysis was applied to evaluate risk factors for Bartholin diseases. 3. Results The sample for 2009 included records of 599 186 female patients from a total sample of 1 116 040 individuals. Mean patient age was 38.1 ± 0.0 years. The number of Bartholin duct cysts in the sample was 587; the number of Bartholin duct abscesses was 757. The incidence of Bartholin duct cysts was 0.55 ± 0.04 per 1000 person-years, and the incidence of Bartholin duct abscesses was 0.95 ± 0.06 per 1000 person-years (Table 1). Among women aged 15–50 years, the incidence of Bartholin duct cysts or abscesses was 2.24 ± 0.12 per 1000 person-years. The incidence of Bartholin duct cysts or abscesses across age groups is shown in Fig. 1. In the logistic regression models, age was associated with Bartholin duct cysts and abscesses in women aged 15–50 years, after adjusting for socioeconomic status and seasonal factors (P b 0.01). Of the patients included in the sample, 59.1% (95% confidence interval [CI], 56.7–61.5) with Bartholin duct cysts or abscesses were treated with surgery, while 40.9% (95% CI, 38.5–43.3) were treated medically. The most common operation was incision and drainage (53.6% [95% CI, 45.3–61.9]), followed by marsupialization (32.4% [95% CI, 24.4–40.4]) and removal of Bartholin duct cyst (13.9% [95% CI, 9.5–18.3]). Table 2 summarizes the operations used for treatment of Bartholin duct cysts and abscesses. Of the patients reviewed, 16.8% (95% CI, 15.0–18.6) had Bartholin duct cysts or abscesses more than twice during 2009; 44.2% (95% CI,
63
Fig. 1. Incidence of Bartholin gland disease by 5-year age intervals. Vertical broken line denotes mean age at menopause in the Republic of Korea.
38.5–49.9) of these women underwent surgical treatment. The monthly proportions of Bartholin duct cysts and abscesses are shown in Fig. 2. 4. Discussion The incidence of Bartholin duct cysts in the present study was 0.55 ± 0.04 per 1000 person-years, and that of Bartholin duct abscesses was 0.95 ± 0.06 per 1000 person-years. When only women aged 15–50 years were included, the incidences were higher than for women of all ages. The incidence of Bartholin duct cysts or abscesses among women aged 15–50 years increased with age until late 40s, when it decreased sharply. According to the Korea National Health and Nutrition Examination Survey 2010 [8], the mean age of Korean women at menopause is 48.6 ± 0.2 years. Notably, this age corresponds to that at which the incidence of Bartholin duct cysts and abscesses sharply decreased in the present sample. The mechanism of this relationship is unknown, but several explanations may account for this observation. It may be that there is an increased tendency at younger ages for the Bartholin ducts to plug because the viscosity of the vaginal fluid and Bartholin gland mucus is higher. Inflammation or trauma can cause trigger points to plug the ducts of the Bartholin glands completely. After menopause, however, the total amount of vaginal fluid and Bartholin gland mucus may decrease; a smaller fluid volume means that there is less chance to plug the Bartholin ducts. Hypoestrogenism associated with aging could also lead to decreased fluid transport and decreased lubrication of the lower genital tract [9]. It has also been reported that hypoestrogenism due to menopause could result in atrophy of the urogenital area [10]. We hypothesized a seasonal relationship in the incidence of Bartholin gland pathologies and an association with socioeconomic status. The Republic of Korea has 4 distinct seasons, and substantial variation in temperature is a feature of the Korean climate. We Table 2 Operation type for Bartholin gland disease.a
Table 1 Incidence of Bartholin gland disease.a
Any Bartholin gland diseaseb Cysts or abscesses Cysts Abscesses Bartholinitis Bartholin gland disease, unspecified a b
Operation type Mean age, y
Incidence, per 1000 person-years
All ages
All ages
15–50 y
39.5 39.5 40.3 39.2 38.9 40.6
1.52 1.44 0.55 0.95 0.05 0.03
2.35 2.24 0.85 1.47 0.08 0.04
Values are expressed as mean ± SEM. Excluding cancer.
± ± ± ± ± ±
05 0.5 0.8 0.7 2.8 3.8
± ± ± ± ± ±
0.07 0.07 0.04 0.06 0.02 0.01
± ± ± ± ± ±
0.12 0.12 0.07 0.10 0.02 0.02
Estimated No. of cases Percentage (95% confidence interval)
Cysts or abscesses Incision 10308 ± 889 Excision 4015 ± 490 Marsupialization 5892 ± 637 Cysts Incision 808 ± 246 Excision 3177 ± 428 Marsupialization 3292 ± 479 Abscesses Incision 9831 ± 845 Excision 1000 ± 230 Marsupialization 2923 ± 443 a
51.0 (47.9–54.1) 19.9 (17.6–22.2) 29.2 (26.4–32) 11.1 (7.9–14.3) 43.7 (38.9–48.5) 45.2 (40.3–50.1) 71.5 (68.2–74.8) 7.3 (5.7–8.9) 21.3 (18.3–24.3)
Values are given as mean ± SEM unless otherwise indicated.
64
J.-S. Yuk et al. / International Journal of Gynecology and Obstetrics 122 (2013) 62–64
The present study had limitations. Diagnosis of Bartholin diseases was not confirmed by biopsy or culture, but was considered confirmed by diagnosis code. This may, therefore, reflect clinical incidence rather than true incidence. In summary, the incidence of Bartholin duct cysts and abscesses among women in the Republic of Korea increased with age until menopause, decreasing sharply thereafter. Conflict of interest The authors have no conflicts of interest.
Fig. 2. Monthly trends in Bartholin gland diseases.
hypothesized that massive changes in temperature could influence the moisture environment of the vulval area, which could lead to a change in the incidence of Bartholin duct cysts and abscesses. Different hygiene practices according to socioeconomic status could also influence the incidence of Bartholin duct cysts and abscesses. However, these hypotheses were wrong. On multivariate logistic regression analysis, age was the only risk factor identified, while other factors such as season and socioeconomic status did not significantly predict disease. This area may require further study. If a record showed the same diagnosis code more than 60 days later, it was assumed to represent a separate episode. In the dataset, 16.8% (95% CI, 15.0–18.6) of women with Bartholin duct cysts or abscesses experienced Bartholin diseases more than twice. These cases included both recurrent ipsilateral disease and new contralateral disease. However, these situations were not distinguished in the present data, and the real recurrence rate may be lower than that presented. However, the data were consistent with the results of another study in which the recurrence rate was reported to be less than 20% [4].
References [1] Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis 2004;8(3):195–204. [2] Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010. [3] Brook I. Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol 2002;15(4):217–26. [4] Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv 2009;64(6):395–404. [5] National Health Insurance Service. The Health Insurance System. http://www.nhic. or.kr/static/html/wbd/g/a/wbdga0101.html. Published 2012. Accessed October 18, 2012. [6] Health Insurance Review and Assessment Service. http://www.hira.or.kr/eng/. Published 2012. Accessed October 18, 2012. [7] Health Insurance Review and Assessment Service. Introduction to HIRA-NPS. https:// www.dropbox.com/sh/gj8quoh6w40pgpl/-g5dis7ybd/Introduction%20to%20HIRA_ NPS.pdf. Published 2012. Accessed October 18, 2012. [8] Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare. Korea National Health and Nutrition Examination Survey. http://knhanes.cdc.go. kr/. Accessed August 27, 2012. [9] Gorodeski GI. Aging and estrogen effects on transcervical-transvaginal epithelial permeability. J Clin Endocrinol Metab 2005;90(1):345–51. [10] Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Juliá MD. Management of postmenopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005;52(Suppl. 1): S46–52.