Bartholin gland cysts are mucus-filled and occur on either side of the vaginal opening. They are the most common large vulvar cysts. Symptoms of large cysts include vulvar irritation, dyspareunia, pain during walking, and vulvar asymmetry. Bartholin gland cysts may form abscesses, which are painful and usually red. Diagnosis is by physical examination. Large cysts and abscesses require drainage and sometimes excision; abscesses require antibiotics.
Bartholin glands are round, very small, nonpalpable, and located deep in the posterolateral vaginal orifice. Obstruction of the Bartholin duct causes the gland to enlarge with mucus, resulting in a cyst. Cause of obstruction is usually unknown. Rarely, the cysts result from a sexually transmitted disease (eg, gonorrhea).
These cysts develop in about 2% of women, usually those in their 20s. With aging, cysts are less likely to develop.
A cyst may become infected, forming an abscess. Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more common in such infections (and in other vulvar infections). Vulvar cancers rarely originate in Bartholin glands (see Vulvar Cancer).
Symptoms and Signs
Most cysts are asymptomatic, but large cysts can be irritating, interfering with sexual intercourse and walking. Most cysts are nontender, unilateral, and palpable near the vaginal orifice. Cysts distend the affected labia majora, causing vulvar asymmetry.
Abscesses cause severe vulvar pain and sometimes fever; they are tender and typically erythematous. A vaginal discharge may be present. Sexually transmitted diseases may coexist.
Diagnosis is usually by physical examination. A sample of discharge, if present, may be tested for sexually transmitted diseases. Abscess fluid should be cultured. In women > 40, biopsy must be done to exclude vulvar cancer.
In women < 40, asymptomatic cysts do not require treatment. Mild symptoms may resolve when sitz baths are used. Otherwise, symptomatic cysts may require surgery. Abscesses also require surgery. Because cysts often recur after simple drainage, surgery aims to produce a permanent opening from the duct to the exterior. Usually, one of the following is done:
Recurrent cysts may require excision.
In women > 40, all cysts must be surgically explored and biopsied or removed.
Abscesses are also treated with oral antibiotic regimens that cover MRSA (eg, trimethoprim 160 mg/sulfamethoxazole 800 mg bid or amoxicillin/clavulanate 875 mg po bid for 1 wk) plus clindamycin (300 mg po qid for 1 wk).
Last full review/revision July 2014 by S. Gene McNeeley, MD
Content last modified July 2014