BARTHOLINI CYST

Definition

By Mayo Clinic staff

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, resulting in relatively painless swelling called a Bartholin cyst. At times, this fluid may become infected, creating a small area of pus surrounded by inflamed tissue (abscess).

A Bartholin cyst or abscess is uncommon. Treatment of Bartholin cyst depends on the size of the cyst, the pain and whether it's 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 necessary to treat the Bartholin cyst.

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 (unilaterally).

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.

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.


When to seek medical advise

Call your doctor if you have a painful lump near the opening of your vagina and it doesn't improve after two or three days of self-care treatment. If the pain is severe, make an appointment with your doctor right away.

If you find a 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.

Test and Diagnosis

A history of your signs and symptoms and a pelvic examination is usually sufficient to make a diagnosis. Your doctor may take a swab of your cervix to test for an accompanying sexually transmitted infection, which may need additional treatment with antibiotics.

If you're postmenopausal or older than 40, your doctor may perform a biopsy of the mass to rule out a possibility of cancer. If cancer is a concern, your doctor may refer you to an obstetrician-gynecologist who specializes in cancers of the female reproductive system.

Complications

It's possible that a Bartholin cyst or abscess may recur, but this is not usually the case. When treated properly, even in the case of recurrent cysts or abscesses, the swelling, pain and infection usually go away.


Treatments and Drugs

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, uncomplicated 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 four to six weeks to keep the opening from closing up and to allow complete drainage. After that, the catheter is 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, your doctor may perform a technique called marsupialization. This method is usually effective in preventing recurrences. It's similar to the surgical drainage procedure, only your doctor places a few stitches on either side of the incision to create a permanent opening, less than one-quarter 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, may be 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 under general anesthesia.

Some doctors are using laser therapy to treat Bartholin cyst but this type of treatment is still in the experimental phase.

Preventions

There's no real way to prevent a Bartholin cyst. However, practicing safe sex — in particular, using a condom — and maintaining good personal hygiene may help to prevent infection of a cyst and the formation of an abscess. If you detect a cyst, treating it right away by soaking in warm water (sitz bath) may help prevent abscess formation, as well.

Lifestyle and home remedies

Daily soaking in warm water, several times a day, may be enough to clear away a Bartholin cyst or abscess.

After surgical procedures to treat a cyst, soaking in warm water (sitz bath) 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.
Jan. 19, 2008

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