Bartholin cyst

Definition

The Bartholin's glands are located on each side of the vaginal opening. These glands secrete fluid that helps lubricate the vagina. Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin cyst. At times, the fluid within the cyst may become infected, resulting in pus surrounded by inflamed tissue (abscess).

A Bartholin cyst or abscess is common. Treatment of a Bartholin cyst depends on the size of the cyst, the pain and whether the cyst is infected. Sometimes home treatment is all you need. In other cases, surgical drainage of the Bartholin cyst is necessary. If an infection occurs, antibiotics may be helpful to treat the infected Bartholin cyst.

Bartholin cyst

Bartholin cyst

The Bartholin's glands are located on each side of the vaginal opening. They secrete fluid that helps lubricate the vagina. Sometimes the ducts of these glands become obstructed and fluid backs up, ...

Symptoms

If the cyst remains small and no infection occurs, you may not notice it. If it grows, you might feel the presence of a lump or mass near your vaginal opening. Although a cyst is usually painless, it can be tender.

If the cyst becomes infected — a full-blown infection can occur in a matter of days — you may experience the following signs and symptoms:

• A tender or painful lump near the vaginal opening
• Discomfort while walking or sitting
• Pain during intercourse
• Fever

A cyst or abscess typically occurs on only one side of the vaginal opening.

When to see a doctor
Call your doctor if you have a painful lump near the opening of your vagina that doesn't improve after two or three days of self-care treatment — for instance, soaking the area in warm water (sitz bath). If the pain is severe, make an appointment with your doctor right away.

If you find a new lump near your vaginal opening and you're older than 40, call your doctor promptly. Although rare, such a lump may be a sign of a more serious problem, such as cancer.

Causes

Experts believe that the cause of a Bartholin cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps by the growth of a flap of skin or because of infection.

A cyst can become infected, forming an abscess. A number of bacteria may cause the infection, including common bacteria, such as Escherichia coli (E. coli), as well as bacteria that cause sexually transmitted diseases such as gonorrhea and chlamydia.

Complications

Bartholin cysts are likely to persist. Abscesses may recur and again require treatment.

Preparing for your appointment

Your first appointment will likely be with either your primary care provider or a doctor who specializes in conditions that affect women (gynecologist).

Because appointments can be brief, and it can be difficult to remember everything you want to discuss, it's a good idea to prepare in advance of your appointment.

What you can do

• Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• Make a list of any medications and vitamin supplements you take. Write down doses and how often you take them.
• Take a notebook or notepad with you. Use it to write down important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out.

Some basic questions to ask include:

• What's likely causing my symptoms?
• What kind of tests might I need?
• Does a Bartholin cyst usually go away on its own, or will I need treatment?
• Are there any self-care measures I can take to relieve my symptoms?
• Do you have any printed material or brochures I can take home with me? What Web sites do you recommend?

If you don't understand something your doctor tells you, don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.

What to expect from your doctor
Some potential questions your doctor might ask include:

• How long have you been experiencing symptoms?
• How severe are your symptoms?
• Do you experience pain during intercourse?
• Do you experience pain during normal daily activities?
• Does anything improve your symptoms?
• Does anything make your symptoms worse?

Tests and diagnosis

To diagnose a Bartholin cyst, your doctor may:

• Ask questions about your medical history.
• Perform a pelvic examination.
• Take a sample of secretions from your vagina or cervix to test for a sexually transmitted infection.
• Recommend a test (biopsy) of the mass to check for cancerous cells — if you're postmenopausal or older than 40.

If cancer is a concern, your doctor may refer you to a gynecologist who specializes in cancers of the female reproductive system.

Treatments and drugs

Often, a Bartholin cyst requires no treatment — especially if the cyst causes no signs or symptoms (asymptomatic). When required, treatment of a Bartholin cyst depends on the size of the cyst, the amount of discomfort it causes and whether it's infected, resulting in an abscess. Here are some of the treatment options your doctor may recommend:

• Sitz baths. Sometimes, soaking in a tub filled with a few inches of warm water (sitz bath) several times a day for three or four days helps a small, infected cyst to rupture and drain on its own.
• Surgical drainage. A cyst that's infected or very large generally requires drainage by a doctor. Drainage of a cyst can be done in your doctor's office under local anesthesia, but in some cases, you and your doctor may opt for general sedation, if that makes you more comfortable. To do the drainage procedure, your doctor makes a small incision in the cyst to allow it to drain. Then he or she places a small rubber tube (catheter) in the incision. The catheter stays in place for up to six weeks to keep the opening from closing and to allow complete drainage. After that, the catheter may fall out on its own or be removed and the incision heals completely.
• Antibiotics. If the cyst is infected, or if testing reveals a sexually transmitted disease, your doctor may prescribe antibiotics to ensure that the bacteria causing the infection are destroyed. But if the abscess is drained properly, you may not need antibiotics.
• Marsupialization. If cysts recur or are bothersome to you, your doctor may perform a procedure called marsupialization. This method is usually effective in preventing recurrences. It's similar to the surgical drainage procedure, only your doctor places stitches on each side of the incision to create a permanent opening, less than 1/4 inch (about 5 millimeters) long. Your doctor may insert a catheter to promote draining for a few days to prevent recurrence. This procedure can be done in your doctor's office but, depending on the complexity of the cyst, is often done in an operating room in the hospital under general anesthesia. Since marsupialization isn't recommended when an active infection is present, your doctor will likely want to drain the abscess first and get rid of the infection, then perform the marsupialization.

If you have persistent recurrences and none of these procedures is successful, your doctor may recommend removal of the Bartholin's gland, but this is rarely necessary. Surgical removal is usually done in a hospital during general anesthesia.

Some doctors are using laser therapy to treat Bartholin cysts, but this type of treatment isn't widely available and is more expensive than other surgical treatments.

Lifestyle and home remedies

Daily soaking in warm water, several times a day, may be adequate to resolve an infected Bartholin cyst or abscess.

After surgical procedures to treat an infected cyst or abscess, soaking in warm water is particularly important. Sitz baths help to keep the area clean, ease discomfort and promote effective drainage of the cyst. Pain relievers also may be helpful. If you have a catheter in place, you may resume your normal activities, including sex, depending on your level of comfort.

Prevention

There's no way to prevent a Bartholin cyst. However, practicing safe sex — in particular, using a condom — and maintaining good hygiene habits may help to prevent infection of a cyst and the formation of an abscess.