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 infection Overview of Sexually Transmitted Infections Sexually transmitted infections (STIs), also termed sexually transmitted diseases or STDs, can be caused by a number of microorganisms that vary widely in size, life cycle, the diseases and... read more (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 Vulvar Cancer Vulvar cancer is usually a squamous cell cancer, most often occurring in older women. It usually manifests as a palpable lesion. Diagnosis is by biopsy. Treatment typically includes excision... read more rarely originate in Bartholin glands.
Symptoms and Signs of Bartholin Gland Cysts
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 Cellulitis Cellulitis is acute bacterial infection of the skin and subcutaneous tissue most often caused by streptococci or staphylococci. Symptoms and signs are pain, warmth, rapidly spreading erythema... read more 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 of Bartholin Gland Cysts
Diagnosis of Bartholin gland cysts is usually by physical examination. A sample of discharge, if present, may be tested for sexually transmitted infections. Abscess fluid should be cultured.
In women > 40, some experts recommend biopsy to exclude vulvar cancer.
Treatment of Bartholin Gland Cysts
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.
For most Bartholin gland cysts, the cause of ductal obstruction is unknown; rarely, cysts result from a sexually transmitted infection.
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).
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