Bartholin gland cysts are a common type of vulvar cyst. They are mucus-filled and are located on either side of the vaginal opening. Symptoms include vulvar and/or perineal pressure or pain, dyspareunia, and vulvar mass. Bartholin gland cysts may form abscesses, which are painful. Diagnosis is by pelvic examination. Large cysts and abscesses may require excision and/or drainage; antibiotics are given if there is accompanying cellulitis.
Bartholin glands are round, very small, nonpalpable, and located deep in the posterolateral vaginal orifice (1). Obstruction of the Bartholin duct causes the gland to enlarge with mucus, resulting in a cyst. Cysts can become infected and form an abscess.
Vulvar Anatomy
The vagina is composed of smooth muscle lined by glandular and squamous epithelium. The urethral meatus is located in the anterior portion of the vaginal introitus. The Skene gland openings are located on both sides of the urethra. The tissue surrounding the vagina is the vulva, which includes the labia minora, labia majora, and the glans and hood of the clitoris (most anteriorly and in the midline, anterior to the urethra). Anterior to the clitoris is the mons pubis (tissue that covers the pubic bone). Posterior to the vagina is the perineum, an area of skin in between the vagina and anus. The crura of the clitoris (purple) extend subcutaneously and are composed of erectile tissue. The bulb of the vestibule (blue) also consists of erectile tissue. Below the bulb is a Bartholin gland, which secretes mucus to lubricate the vagina. BO VEISLAND/SCIENCE PHOTO LIBRARY |
Bartholin gland cysts develop in about 3% of women, usually those in their 20s (2). With aging, cysts are less likely to develop.
A cyst may become infected, forming an abscess. Methicillin-resistant Staphylococcus aureus (MRSA) has become more common in such infections (and in other vulvar infections). Rarely, infection is due to a sexually transmitted infection (eg, gonorrhea).
Rarely, a vulvar cancer develops in a Bartholin gland.
General references
1. De Bortoli J, Chowdary P, Nikpoor P, Readman E. Clinical approach to vulvovaginal cysts and abscesses, a review. Aust N Z J Obstet Gynaecol. 2018;58(4):388-396. doi:10.1111/ajo.12822
2. Berger MB, Betschart C, Khandwala N, et al. Incidental Bartholin gland cysts identified on pelvic magnetic resonance imaging. Obstet Gynecol 2012;120(4):798-802. doi:10.1097/AOG.0b013e3182699259
Symptoms and Signs of Bartholin Gland Cyst or Abscess
Most Bartholin gland cysts are asymptomatic, but large cysts can cause pressure or pain, and interfere with sexual activity, sitting, or walking. Most cysts are nontender, unilateral, and palpable near the vaginal orifice. Cysts distend the affected tissue, causing vulvar asymmetry or a mass.
By permission of the publisher. From Kaufman R, Brown D. In Atlas of Clinical Gynecology: Gynecologic Pathology. Edited by M Stenchever (series editor) and B Goff. Philadelphia, Current Medicine, 1998.
If an abscess develops, it causes severe vulvar pain and sometimes fever; abscesses are tender and typically erythematous. Cellulitis with localized erythema and tenderness may develop. A vaginal discharge may be present.
Diagnosis of Bartholin Gland Cyst or Abscess
History and physical examination
Diagnosis of Bartholin gland cysts is usually by examination of the vulva.
A sample of discharge from the cyst, if present, may be tested for sexually transmitted infections. If an abscess is present, its contents should be cultured.
Bartholin gland carcinoma is rare and risk factors have not be determined. Biopsy of the gland should be performed if there is any suspicion of malignancy, eg, due to a solid or fixed mass or gland or lack of response to treatment. Cysts that have been present for years and have not changed in appearance do not require biopsy or surgical removal unless symptoms are present. Some experts advise biopsy in patient patients ≥ 40 years old or in postmenopausal patients.
Treatment of Bartholin Gland Cyst or Abscess
Sitz baths for mild symptoms
For abscesses, incision and drainage and usually placement of a catheter for drainage
Surgical excision of the gland is considered for recurrent cysts or abscesses or if there is suspicion of malignancy
Bartholin cysts that are asymptomatic do not require treatment. Mild symptoms may resolve with sitz baths.
If symptoms persist, a procedure is required to drain or remove the cyst. A permanent opening from the gland to the exterior is made because cysts often recur after simple drainage. A small incision is made in the cyst, and then one of the following is done:
Word 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.
Bartholin abscesses are treated with an incision and drainage procedure, usually with placement of a Word catheter. Antibiotics are typically given post-procedure only if risk factors for severe infection are present. These include cellulitis surrounding the gland, signs of systemic infection (eg, fever), recurrent abscess, or risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection. Oral antibiotic regimens should cover MRSA (eg, trimethoprim/sulfamethoxazole with or without amoxicillin-clavulanate OR trimethoprim/sulfamethoxazole plus metronidazole). Inpatient admission for IV antibiotics is recommended in patients with poorly controlled diabetes mellitus or immunocompromise.. Oral antibiotic regimens should cover MRSA (eg, trimethoprim/sulfamethoxazole with or without amoxicillin-clavulanate OR trimethoprim/sulfamethoxazole plus metronidazole). Inpatient admission for IV antibiotics is recommended in patients with poorly controlled diabetes mellitus or immunocompromise.
Recurrence of a Bartholin cyst or abscess occurs in approximately 7 to 9% of patients treated with Word catheter or marsupialization (1).
Complete Bartholin gland excision may be required if cysts or abscessed recur or if there is suspicion of a Bartholin gland carcinoma.
Treatment reference
1. Bakouei F, Zolfaghari F, Mirabi P, Farhadi Z, Delavar MA. Comparison of Word Catheter and Marsupialization in the Management of Bartholin's Glands: A Systematic Review and Meta-Analysis. J Obstet Gynaecol Can. 2024;46(4):102357. doi:10.1016/j.jogc.2024.102357
Key Points
Bartholin gland cysts are vulvar cysts.
They result from ductal obstruction, and then a cyst develops.
Cysts may become infected, sometimes with MRSA, and form an abscess.
For cysts that cause bothersome symptoms and abscesses, treat with an incision and drainage procedure (eg, with catheter insertion, marsupialization, and/or excision).
Surgically remove a Bartholin gland if a patient has recurrent cysts or abscesses or if cancer is suspected.
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