Definition and Overview

The Bartholin’s glands are pea-sized paired glands located at the vaginal opening between the labia minora and hymenal ring (at approximately 5 and 7 o’clock positions). When they are not swollen or infected, they cannot be palpated and are not visible to the naked eye. These glands secrete fluid for lubrication during sex, which is released through tubes called Bartholin’s ducts.

Bartholin’s cysts occur when the Bartholin’s ducts are blocked, which causes the fluid to back up and accumulate in the glands. Swollen Bartholin’s glands are rarely a cause for concern because they do not produce any worrying symptoms. Often, they resolve on their own or are managed with simple home care remedies such as taking sitz baths for up to five days. However, an infected Bartholin’s cyst causes an abscess to form, which results in pain, swollen vulva, chills, and fever. Bartholin’s abscess can be treated with drainage, antibiotics, and in some cases, a simple surgical procedure to keep the Bartholin’s tubes open.

Bartholin’s cysts are very common and usually affect sexually active women aged between 20 and 30.

Causes of Condition

Bartholin’s cysts develop when Bartholin’s ducts are blocked, which prevents the fluid from flowing from the Bartholin’s glands to the outer genital area. As the fluid builds up, the Bartholin’s tubes expand to form a cyst. The blockage can be caused by sexually transmitted diseases and other bacterial infections, including those that cause gonorrhea (gonococcus), chlamydia (Chlamydia trachomatis), haemorrhagic colitis (Escherichia coli or E.coli), pneumonia (Streptococcus pneumonia), and respiratory infections (Haemophilus influenza).

Key Symptoms

Small, uninfected cysts are generally painless and asymptomatic. Thus, it is very common for women to have them without them realising it. Often, the cysts are detected by doctors during routine gynaecological tests, such as pap smear and pelvic exam.

Bigger cysts produce the following symptoms:

  • A noticeable lump in the labia

  • Abscess, if the cyst is infected

  • Fever

  • Pain and discomfort in the vulva, which usually intensifies during sexual intercourse

  • Red or swollen labia

Who to See and Types of Treatments Available

Any lump in the genital area should prompt a woman to consult either a family physician or gynaecologist. Although Bartholin’s cysts are generally not a cause for concern, some lumps in the vulva can be a sign of more serious conditions, such as cancer.

To diagnose a Bartholin’s cyst and rule out other medical conditions, the following tests and procedures are performed:

  • Review of the patient’s medical history

  • Pelvic exam - A standard gynaecologic test used to evaluate the female reproductive system. It is a very straightforward procedure that lasts only a few minutes. For the test, the doctor will first look at the vulva to check for sores, irritation, redness, swelling, and other abnormalities. The doctor may also elect to perform an internal visual exam in which a speculum is used to assess the vagina and cervix.

  • Endocervical culture - A test to screen for sexually transmitted infections.

  • Biopsy - Depending on the patient’s risk factors and family history, the doctor may elect to remove the cyst and test it to see if it is malignant or cancerous.

Treatment

Small, uninfected cysts usually go away without treatment or managed with home care remedies, such as abstaining from sex until the condition resolves and taking sitz baths.

Infected cysts, on the other hand, may be treated with:

  • Antibiotics

  • Needle aspiration - A routine procedure to drain the fluid and pus. To minimise the risk of infection, the cyst is usually filled with alcohol liquid solution before it is drained.

  • Marsupialisation - A surgical technique that involves cutting a slit into the cyst and suturing its edges to form a permanent opening.

  • Bartholin’s gland excision - This is indicated for persistent and recurrent Bartholin’s cysts and abscesses. Although considered a minor surgical procedure, the excision of a Bartholin’s cyst is one of the bloodiest surgeries in gynaecology because the vulva has an extensive blood supply. Thus, it is best that the procedure is performed in a surgical setting.

A local anaesthetic is often used to ensure the patient will not feel any pain during the procedure. However, in some cases, general anaesthesia can also be used to put the patient to sleep.

Bartholin’s gland excision has risks and possible complications, including:

  • Infection

  • Bleeding

  • Chest infection

  • Blood clot formation

References:

  • Hillard PJA (2012). Benign diseases of the female reproductive tract. In JS Berek, ed., Berek and Novak’s Gynecology, 15th ed., pp. 374–437. Philadelphia: Lippincott Williams and Wilkins.

  • Mazdisnian F (2007). Bartholin’s duct cyst and abscess section of Benign disorder of the vulva and vagina. In AH DeCherney et al., eds., Current Diagnosis and Treatment in Obstetrics and Gynecology, 10th ed., pp. 618–619. New York: McGraw-Hill.

  • Reif P, Ulrich D, Bjelic-Radisic V, Häusler M, Schnedl-Lamprecht E, Tamussino K. Management of Bartholin’s cyst and abscess using the Word catheter: implementation, recurrence rates and costs. Eur J Obstet Gynecol Reprod Biol. 2015 Jul. 190:81-4.

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