A Bartholin's cyst occurs when a
Bartholin's gland
The Bartholin's glands (named after Caspar Bartholin the Younger; also called Bartholin glands or greater vestibular glands) are two pea sized compound alveolar glandsManual of Obstetrics. (3rd ed.). Elsevier. pp. 1-16. . located slightly poster ...
within the
labia
The labia are part of the female genitalia; they are the major externally visible portions of the vulva. In humans, there are two pairs of labia: the ''labia majora'' (or the outer labia) are larger and thicker, while the ''labia minora'' are fol ...
becomes blocked.
Small cysts may result in minimal or no symptoms.
Larger cysts may result in swelling on one side of the vagina, as well as pain during sex or walking.
[ If the cyst becomes infected, an ]abscess
An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...
can occur, which is typically red and very painful. If there are no symptoms, no treatment is needed. Bartholin's cysts affect about 2% of women at some point in their life. They most commonly occur during childbearing years.
When the cyst becomes uncomfortable or painful, drainage is recommended. The preferred method is the insertion of a Word catheter for four weeks, as recurrence following simple incision and drainage
Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with a ...
is common. A surgical procedure known as marsupialization
400px, Marsupialization
Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. ...
may be used or, 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
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
are not generally needed to treat a Bartholin's cyst.
The cause of a Bartholin's cyst is unknown. An abscess results from a bacterial infection, but it is not usually a sexually transmitted infection
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are Transmission (medicine), spread by Human sexual activity, sexual activity, especi ...
(STI). Rarely, gonorrhea
Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium '' Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with ...
may be involved. Diagnosis is typically based on symptoms and examination. In women over the age of 40, a tissue biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
is often recommended to rule out cancer
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
.
The cyst is named after Caspar Bartholin who accurately described the glands in 1677. The underlying mechanism of the cyst was determined in 1967 by 20th Century obstetrician Samuel Buford Word.[
]
Signs and symptoms
Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[ or sexual intercourse (]dyspareunia
Dyspareunia ( ) is painful sexual intercourse due to medical or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...
). They are usually between 1 and 4 cm, and are located just medial to the labia minora
The labia minora (Latin for 'smaller lips', singular: ''labium minus'', 'smaller lip'), also known as the inner labia, inner lips, vaginal lips or nymphae are two flaps of skin on either side of the human vaginal opening in the vulva, situated be ...
. Most Bartholin's cysts only affect the left ''or'' the right side (unilateral
__NOTOC__
Unilateralism is any doctrine or agenda that supports one-sided action. Such action may be in disregard for other parties, or as an expression of a commitment toward a direction which other parties may find disagreeable. As a word, ''un ...
). While small cysts are usually not painful, larger cysts can cause significant pain.
Pathophysiology
A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked. Blockage may be caused by an infection or a mucus plug. The secretions from the Bartholin's gland are retained, forming a cyst.[
]
Diagnosis
Other conditions that may present similarly include hidradenoma papilliferum
Hidradenoma refers to a benign adnexal tumor of the apical sweat gland. These are 1–3 cm translucent blue cystic nodules. It usually presents as a single, small skin-colored lesion, and may be considered closely related to or a variant of ...
, lipoma
A lipoma is a benign tumor made of fat tissue. They are generally soft to the touch, movable, and painless. They usually occur just under the skin, but occasionally may be deeper. Most are less than in size. Common locations include upper back, ...
s, epidermoid cysts
An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.
Signs and symptoms
The epidermoid cyst may ...
and Skene's duct cyst
In female human anatomy, Skene's glands or the Skene glands ( , also known as the lesser vestibular glands, paraurethral glands) are glands located around the lower end of the urethra. The glands are surrounded by tissue that swells with blood d ...
s, among others conditions.[ In women who are more than 40 years, a ]biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
may be recommended to rule out cancer.[
]
Treatment
If the Bartholin's cysts is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. 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, to alleviate swelling and discomfort.
Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.[ 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
400px, Marsupialization
Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. ...
, which involves opening the gland through an incision to ensure that the secretion channel remains 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
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for treating pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It may also be used to close a patent ductus arte ...
relieves pain, and a sitz bath
A sitz bath or hip bath is a bath in which a person sits in water up to the hips. It is used to relieve discomfort and pain in the lower part of the body, for example, due to hemorrhoids (piles), anal fissures, perianal fistulas, rectal surgery, ...
may increase comfort and reduce pain. Warm compresses can also speed up 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
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
or laser
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The fir ...
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.[ 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.] The incidence of Bartholin duct cysts increases with age until menopause
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...
, and decreases thereafter. Hispanic women may be more often affected than white women and black women.[ The risk of developing a Bartholin's gland cyst increases with the number of childbirths.][
]
References
External links
{{DEFAULTSORT:Bartholin's Cyst
Inflammatory diseases of female pelvic organs
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