Bartholin's cyst

A Bartholin's cyst, also known as Bartholinitis occurs when a Bartholin's gland is blocked and the gland becomes inflamed.^[1] Sizes range from that of a pea to that of an egg and form just within each side of the lower part of the opening of the vagina. An abscess may form if the cyst becomes infected.^[2] In this case it often becomes red and painful when touched.^[2]

A Bartholin's cyst is not an infection, although it can be caused by an infection, inflammation, or physical blockage (mucus or other impediment) to the Bartholin's ducts (tubes which lead from the glands to the vulva). If infection sets in, the result is a Bartholin's abscess. Cysts are not sexually transmitted. There is no known reason for their development and infection is rare. With an abscess, a bacterial infection, but usually not an STD, is the cause.^[3]

Treatment depends on the severity of symptoms. If there are no symptoms, no treatment may be needed. If a cyst is causing problems, drainage is recommended. The preferred method of drainage is the insertion of a Word catheter for four weeks. Simple incision and drainage may allow the cyst to reform. A surgical procedure known as marsupialization may be used for cysts, but should not be used if they are infected. If the problems persist, the entire gland may be removed. Removal is sometimes recommended in those older than 40 to ensure cancer is not present. Antibiotics are not generally needed.^[2]

Bartholin's cysts are most likely in women of childbearing age. About two percent of women have the problem at some point in their life.^[2]

Signs and symptoms

Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,^[2] or sexual intercourse (dyspareunia).^[4] They are usually between 1 and 4 cm, and are located just medial to the labia minora. Most Bartholin's cysts only affect the left or the right side (unilateral). Small cysts are usually not painful, but very large cysts can cause significant pain.

Pathophysiology

A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked.^[4] Blockage may be caused by an infection or a mucus plug.^[4] The secretions from the Bartholin's gland are retained, forming a cyst.^[2]

Diagnosis

Other conditions that may present similarly include hidradenoma papilliferum, lipomas, epidermoid cysts and Skene's duct cysts among others.^[2] In those who are more than 40 years of age a biopsy may be recommended to ensure cancer is not present.^[2]

Treatment

Treatment may not be necessary when Bartholin's cysts cause no symptoms. Small, asymptomatic cysts should simply be observed over time to see whether they grow. In cases that require intervention, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, for the achievement of absence of swelling and discomfort and the appearance of a freely draining duct.^[5]

Catheterization is a minor procedure that can be performed in an office setting. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.^[2] The balloon is then inflated to keep it in place. The catheter stays in place for 2 to 4 weeks, draining the fluid and causing a normal gland opening to form, after which the catheter is removed. The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.

Cysts may also be opened permanently, a procedure called marsupialization,^[6] in which an opening to the gland is formed with stitches to hold the secretion channel open.

If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Nonprescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort. Warm compresses can speed healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.

Prognosis

While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgical or laser removal of a cyst makes it less likely that a new one will form at the same site. Those with a cyst are more likely than those without a cyst to get one in the future. They can recur every few years or more frequently. Many women who have marsupialization done find that the recurrences may slow, but do not actually stop.

Epidemiology

Two percent of women will have a Bartholin's gland cyst at some point in their lives.^[2] They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years.^[7] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter.^[7] Hispanic women may be more often affected than white women and black women.^[2] The risk of developing a Bartholin's gland cyst increases with the number of childbirths.^[2]

References