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Bartholin Gland Cysts

(Bartholin's Cyst)

By S. Gene McNeeley, MD

Bartholin gland cysts are mucus-filled sacs that can form when the glands located near the opening to the vagina are blocked.

  • Cysts are usually painless, but if large, they can interfere with sitting, walking, and sexual intercourse.

  • Cysts may become infected, forming a painful abscess.

  • Doctors can usually see or feel the cysts during a pelvic examination.

  • Doctors may create a permanent opening from the cyst to the outside or may surgically remove the cyst.

Bartholin glands are very small, round glands that are located in the vulva on either side of the opening to the vagina. Because they are located deep under the skin, they cannot normally be felt. These glands may help provide fluids for lubrication during sexual intercourse.

If the duct to the gland is blocked, the gland becomes filled with mucus and enlarges. The result is a cyst. These cysts develop in about 2% of women, usually those in their 20s. Cysts may become infected, forming an abscess. As women age, they are less likely to have cysts and abscesses.

Typically, what causes the blockage is unknown. Rarely, cysts result from a sexually transmitted disease, such as gonorrhea.

What Is Bartholin Gland Cyst?

The small glands on either side of the vaginal opening, called Bartholin glands, may become blocked. Fluids then accumulate, and the gland swells, forming a cyst. Cysts range from the size of a pea to that of a golf ball or larger. Most often, they occur only on one side. They may become infected, forming an abscess.

Symptoms

Most cysts do not cause any symptoms. But if cysts become large, they can cause discomfort during sitting, walking, or sexual intercourse. Women may notice a painless lump near the opening of the vagina, making the vulva look lopsided.

Abscesses cause severe pain and sometimes fever. They are tender to the touch. The skin over them appears red. Women may have a discharge from the vagina, which is usually unrelated to the abscess.

Diagnosis

  • Pelvic examination

  • Sometimes a biopsy

A woman should see a doctor in the following circumstances:

  • The cyst continues to enlarge or persists after several days of immersing the area in hot water (in a tub or sitz bath).

  • The cyst is painful (often indicating an abscess).

  • A fever develops.

  • The cyst interferes with walking or sitting.

  • She is over 40.

If a cyst is large enough for a woman to notice it or for symptoms to develop, doctors can see or feel the cyst during a pelvic examination (see Gynecologic Examination). Doctors can usually tell whether it is infected by its appearance. If a discharge is present, doctors may send a sample to be tested for other infections, including sexually transmitted diseases. If an abscess has developed, doctors also culture fluid from the abscess.

Because cancer of the vulva sometimes resembles a cyst, doctors may remove the cyst to examine under a microscope (biopsy). A biopsy is usually done if the cyst is irregular or bumpy or if the woman is over 40.

Treatment

  • Soaking the area on warm water

  • If a cyst causes symptoms or occurs in women over 40, surgery

If a cyst causes little or no pain, women may treat it themselves. They can use a sitz bath or soak in a few inches of warm water in a tub. Soaks should last 10 to 15 minutes and be done 3 or 4 times a day. Sometimes cysts disappear after a few days of such treatment. If the treatment is ineffective, women should see a doctor.

In women under 40, only cysts that cause symptoms require treatment. Draining the cysts is usually ineffective because they commonly recur. Thus, surgery may be done to make a permanent opening from the gland’s duct to the surface of the vulva. Thus, if fluids refill the cyst, they can drain out. After a local anesthetic is injected to numb the site, one of the following procedures can be done:

  • Placement of a catheter: A small incision is made in the cyst so that a small balloon-tipped tube (catheter) can be inserted into the cyst. Once in place, the balloon is inflated, and the catheter is left there for 4 to 6 weeks, so that a permanent opening can form. The catheter is inserted and removed in the doctor’s office. Women can do their normal activities while the catheter is in place, although sexual intercourse may be uncomfortable.

  • Marsupialization: Doctors make a small cut in the cyst and stitch the inside edges of the cyst to the surface of the vulva. This procedure is done in an outpatient operating room. Sometimes general anesthesia is needed.

After these procedures, women may have a discharge for a few weeks. Usually, wearing panty liners is all that is needed. Taking sitz baths several times a day may help relieve any discomfort and help speed healing.

If cysts recur, they may be surgically removed. This procedure is done in an operating room.

In women aged 40 or older, all cysts must be treated. Treatment involves

  • Surgically removing the entire cyst

  • Removing part of the cyst to test for cancer, then marsupializing the cyst

For an abscess, antibiotics are given by mouth for 1 week. A catheter can be inserted to drain the abscess or marsupialization may be done initially to treat the abscess or later to prevent the cyst from refilling.

Regardless of treatment, cysts sometimes recur.

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