Definition and Overview
A Bartholin’s cyst is a fluid-filled sac that develops inside the opening of the vagina. These cysts often manifest as small painless lumps that are soft to the touch and are generally benign. They form around the Bartholin’s glands, which are a pair of pea-sized racemose glands in the left and right side of the vaginal opening. The glands are responsible for secreting mucus to lubricate the vagina.
The Bartholin’s glands can become blocked and inflamed, which leads to the development of cysts in the vaginal opening. When a Bartholin’s cyst becomes inflamed, the condition is known as bartholinitis, which could form an abscess when the cyst becomes infected, typically by contact with bacteria. This infected cyst feels painful and hot and has an intense red colour.
Who Should Undergo and Expected Results
Women with symptomatic Bartholin’s cysts or abscesses can undergo an excision procedure to ease the symptoms. When performed properly, the procedure can treat the condition and prevent the reoccurrence of such problems in the future.
The treatment of Bartholin’s cysts typically depends on the severity of the symptoms. Most patients do not experience any symptoms, which means that no treatment will be required or prescribed. However, surgical intervention is recommended if the cysts are causing serious problems, including pain when performing normal activities, such as having sex, walking, or sitting down.
Prior to the procedure, a general practitioner or an obstetric-gynaecologist (OB-GYNE) will swab the area to analyse the discharge and if needed, recommend a biopsy to determine if the cysts can be safely excised or are symptoms of a more serious problem, such as the rare vulval cancer.
Typically, the doctor will recommend an excision in the event that abscesses develop. Larger cysts can also be drained to prevent the likelihood of reoccurrence.
How is the procedure performed?
There are two main surgical techniques used in excising Bartholin’s cysts: through the insertion of a balloon catheter or via marsupialisation.
The balloon catheter technique, also known as fistulisation or catheter placement, drains the fluid—mucus or pus—inside a Bartholin’s cyst. This outpatient procedure follows the steps listed below:
- The patient is placed under local anesthesia, which means that she will be conscious throughout the duration of the procedure but the area where the cysts are located will be numbed. Anxious patients can opt for general anesthesia, where they will be asleep during the procedure and will not feel any pain or discomfort.
- The surgeon makes an incision in the abscess or cyst to drain the fluid.
- Once the cyst or abscess is empty, the surgeon will insert a catheter with an inflatable balloon on one end.
- The balloon is filled with a saline solution. The balloon will inflate as water fills it and will eventually fill up the space inside the cyst or abscess.
- The surgeon will partially suture the incision made at the beginning of the procedure, leaving enough opening for the thin tube of the catheter.
- The catheter will remain in place as the wound heals. New cells will grow around the catheter in a process called epithelialisation.
After the epithelialisation process, the balloon will be drained and the catheter will be removed.
The marsupialisation technique is often recommended for patients with recurring cysts and abscesses, and is performed with the following steps:
The patient will be placed under general anesthesia.
- The surgeon will make an incision in the cyst or abscess.
- The fluid will be drained out from the incision.
- The surgeon will then stitch up the edges of the skin around the cyst or abscess, creating a small pouch like that seen in marsupials. The pouch will facilitate further draining of additional fluid.
- The surgeon will pack the area with a sterile dressing to soak up the remaining fluid and stop the bleeding.
Both procedures can be performed on an outpatient basis, with the patient immediately discharged after the effects of anesthesia have worn off.
Possible Risks and Complications
Possible risks and complications of a balloon catheter excision procedure include:
- Pain around the area where the catheter is inserted as the patient is waiting for epithelialisation
- Discomfort or pain during sexual intercourse
- Swelling of the labia, or the lips around the vaginal opening
- Excessive bleeding during the procedure
- Unsightly scarring
Infection around the wound
The marsupialisation technique, on the other hand, can result in the following:
- Recurrence of the cyst or abscess
- Excessive bleeding
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.
Fambrini M, Penna C, Pieralli A, Fallani MG, Andersson KL, Lozza V, et al. Carbon-dioxide laser vaporization of the Bartholin gland cyst: a retrospective analysis on 200 cases. J Minim Invasive Gynecol. 2008 May-Jun. 15(3):327-31.