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Bartholin Gland Cysts

(Bartholin's Gland Cyst)

By

Charlie C. Kilpatrick

, MD, MEd, Baylor College of Medicine

Last full review/revision May 2019| Content last modified May 2019
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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).

Bartholin gland 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.

Symptoms and Signs

Most Bartholin gland 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.

Cellulitis with localized erythema and tenderness may develop. 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

  • Clinical evaluation

Diagnosis of Bartholin gland cysts 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, some experts recommend biopsy to exclude vulvar cancer.

Treatment

  • Sitz baths for mild symptoms

  • Surgery for more severe symptoms and for all cysts in women > 40

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:

  • Catheter insertion: A small balloon-tipped catheter may be inserted, inflated, and left in the cyst for 4 to 6 weeks; this procedure stimulates fibrosis and produces a permanent opening.

  • Marsupialization: The everted edges of the cyst are sutured to the exterior.

Recurrent cysts may require excision.

In women > 40, newly developed cysts should be surgically biopsied (to exclude vulvar cancer) or removed. Cysts that have been present for years and have not changed in appearance do not require biopsy or surgical removal unless symptoms are present.

Abscesses are sometimes also treated with oral antibiotic regimens that cover MRSA (eg, trimethoprim 160 mg/sulfamethoxazole 800 mg twice a day or amoxicillin/clavulanate 875 mg twice a day for 1 week) plus clindamycin (300 mg 4 times a day for 1 week). Oral antibiotics should be used when cellulitis is also present; antibiotics should be chosen based on that region's antibiogram. Inpatient admission for IV antibiotics should be strongly considered if patients have poorly controlled diabetes mellitus or are immunocompromised.

Key Points

  • For most Bartholin gland cysts, the cause of ductal obstruction is unknown; rarely, cysts result from a sexually transmitted disease.

  • Cysts may become infected, often with MRSA, and form an abscess.

  • In women > 40, biopsy newly developed cysts to exclude vulvar cancer or remove them.

  • If cysts cause bothersome symptoms, treat surgically (eg, with catheter insertion, marsupialization, and/or excision).

Drugs Mentioned In This Article

Drug Name Select Trade
No US brand name
AMOXIL
CLEOCIN
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