Bartholin's Gland Cyst

Bartholin's Gland Cyst 

Definition

A Bartholin's gland cyst is a swollen fluid-filled lump that develops from a blockage of one of the Bartholin's glands, which are small glands located on each side of the opening to the vagina. Bartholin's gland cysts and abscesses are commonly found in women of reproductive age, developing in approximately 2% of all women.

Description

The Bartholin's glands are located in the lips of the labia that cover the vaginal opening. The glands (normally the size of a pea) provide moisture for the vulva area. A Bartholin's gland cyst may form in the gland itself or in the duct draining the gland. A cyst normally does not cause pain, grows slowly, and may go away without treatment. It usually ranges in size from 0.4-1.2 in. (1-3 cm), although some may grow much larger.

If infected, a Bartholin's gland cyst can form an abscess that will increase in size over several days and is very painful. In order to heal, a Bartholin's gland cyst usually must be drained.

Causes and symptoms

A Bartholin's gland cyst occurs if the duct becomes blocked for any reason, such as infection, injury, or chronic inflammation. Very rarely a cyst is caused by cancer, which usually occurs only in women over the age of 40. In many cases, the cause of a Bartholin's gland cyst is unknown.

Symptoms of an uninfected Bartholin's gland cyst include a painless jump on one side of the vulva area (most common symptom) and redness or swelling in the vulva area.

Symptoms of an abscessed Bartholin's gland include:

• pain that occurs with walking, sitting, physical activity, or sexual intercourse
• fever and chills
• increased swelling in the vulva area over a two- to four-day period
• drainage from the cyst, normally occurring four to five days after the swelling starts

Abscesses may be caused by sexually transmitted bacteria, such as those causing chlamydial or gonococcal infections, while others are caused by bacteria normally occurring in the vagina. Over 60 types of bacteria have been found in Bartholin's gland abscesses.

Diagnosis

A Bartholin's gland cyst or abscess is diagnosed by a gynecological pelvic exam. If the cyst appears to be infected, a culture is often performed to identify the type of bacteria causing the abscess.

Treatment

Treatment for this condition depends on the size of the cyst, whether it is painful, and whether the cyst is infected.

If the cyst is not infected, treatment options include:

• watchful waiting by the woman and her health care professional
• soaking of the genital area with warm towel compresses
• soaking of the genital area in a sitz bath
• use of non-prescription pain medication to relieve mild discomfort

Key terms

Marsupialization — Cutting out a wedge of the cyst wall and putting in stitches so the cyst cannot reoccur.

Sitz bath — A warm bath in which just the buttocks and genital area soak in water; used to reduce pain and aid healing in the genital area.

Window operation — Cutting out a large oval-shaped piece of the cyst wall and putting in stitches to create a window so the cyst cannot reoccur.

Word catheter — A small rubber catheter with an inflatable balloon tip that is inserted into a stab incision in the cyst, after the contents of the cyst have been drained.

If the Bartholin's gland is infected, there are several treatments available to treat the abscess, including:

• soaking of the genital area in a sitz bath
• treatment with antibiotics
• use of prescription or non-prescription pain medication
• incision and drainage, i.e., cutting into the cyst and draining the fluid (not usually successful, as the cyst often reoccurs)

• placement of a drain (Word catheter) in the cyst for two to four weeks so fluid can drain and prevent reoccurrence of the cyst
• marsupialization
• window operation
• use of a carbon dioxide laser to open the cyst and heat the cyst wall tissue so that the cyst cannot form a sac and reoccur
• incision and drainage, followed by treatment with silver nitrate to burn the cyst wall so the cyst cannot form a sac and reoccur
• removal of the entire Bartholin's gland cyst, if the cyst has reoccurred several times after use of other treatment methods

During surgical treatment, the area will be numbed with a local anesthetic to reduce pain. General anesthesia may be used for treatment of an abscess, as the procedure can be painful.

In a pregnant woman, surgical treatment of cysts that are asymptomatic should be delayed until after delivery to avoid the possibility of excessive bleeding. However, if the Bartholin's gland is infected and must be drained, antibiotics and local anesthesia are generally considered safe.

If the cyst is caused by cancer, the gland must be excised, and the woman should be under the care of a gynecologist familiar with the treatment of this type of cancer.

Alternative treatment

If a Bartholin's gland cyst has no or mild symptoms, or has opened on its own to drain, a woman may decide to use watchful waiting, warm sitz baths, and non-prescription pain medication. If symptoms become worse or do not improve, a health care professional should then be consulted.

Infected Bartholin's glands should be evaluated and treated by a health care professional.

Prognosis

A Bartholin's gland cyst should respond to treatment in a few days. If an abscess requires surgery, healing may take days to weeks, depending on the size of the abscess and the type of surgical procedure used. Most of the surgical procedures, except for incision and drainage, should be effective in preventing recurring infections.

Prevention

There are few ways to prevent the formation of Bartholin's gland cysts or abscesses. However, as a Bartholin's gland abscess may be caused by a sexually transmitted disease, the practice of safe sex is recommended. Using good hygiene, i.e., wiping front to back after a bowel movement, is also recommended to prevent bacteria from the bowels from contaminating the vaginal area.

Resources

Books

Toth, P. P. "Management of Bartholin's Gland Duct Cysts and Abscesses." In Saunders Manual of Medical Practice. Philadelphia: W.B. Saunders, 2000.