What Is Bartholin Gland Cyst?

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Introduction

The Bartholin’s glands are located on each side of the vaginal opening. They’re about the size of a pea. They produce fluid that keeps the vagina moist.

The fluid travels to the vagina through ducts (tubes). If they become blocked, fluid can back up into them. This forms a swelling a cyst. Doctors call these Bartholin’s gland cysts. Most of the time, they don’t hurt. They’re almost always benign, or non-cancerous.

The two Bartholin’s glands are located at the entrance to a woman’s vagina, one on each side. They are small and cannot be seen or felt when they are normal. Their function is to secrete fluid onto the mucosal (inner) surface of the labia-the liplike skin surrounding the vagina.

Problems with the Bartholin’s glands include cysts, which are relatively painless enlargements of the gland, and abscesses, which are infections of the gland. Typically only one of the two glands is affected.

A Bartholin’s cyst occurs when a Bartholin’s gland is blocked and the gland becomes inflamed. 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. In this case it often becomes red and painful when touched.

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 is the cause, but it is usually not an STI.

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.

Bartholin’s cysts only occur in women and most likely those of childbearing age. About two percent of women have the problem at some point in their life.

The Bartholin’s (BAHR-toe-linz) 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. The result is relatively painless swelling called a Bartholin’s cyst. If the fluid within the cyst becomes infected, you may develop a collection of pus surrounded by inflamed tissue (abscess).

A Bartholin’s cyst or abscess is common. Treatment of a Bartholin’s cyst depends on the size of the cyst, how painful the cyst is and whether the cyst is infected.

Sometimes home treatment is all you need. In other cases, surgical drainage of the Bartholin’s cyst is necessary. If an infection occurs, antibiotics may be helpful to treat the infected Bartholin’s cyst.

Bartholin glands are very small, round glands that are located in the vulva on either side of the opening to the vagina. Because they are located deep under the skin, they cannot normally be felt. These glands may help provide fluids for lubrication during sexual intercourse.

If the duct to the gland is blocked, the gland becomes filled with mucus and enlarges. The result is a cyst. These cysts develop in about 2% of women, usually those in their 20s. Cysts may become infected, forming an abscess. As women age, they are less likely to have cysts and abscesses.

Typically, what causes the blockage is unknown. Rarely, cysts result from a sexually transmitted disease, such as gonorrhea.

The Bartholin’s gland is a tiny organ on each of the labia (vaginal lips), near the opening of the vagina. If the vagina were the face of a clock, these glands would be found at about 4 and 8 o’clock. Normally they are invisible. They make a small amount of fluid that lubricates the vaginal lips. If a flap of skin grows over the opening of one of the glands, the fluid backs up. It causes a round swelling called a cyst. The cyst can grow from the size of a penny to larger than an orange. Most don’t get bigger than a golf ball. Cysts can be tender.

Causes

Doctors aren’t sure why the glands sometimes become blocked. In rare cases, it may be due to a sexually transmitted infection (STI) like gonorrhea or chlamydia.

About two out of 10 women can expect to get a Bartholin’s gland cyst at some point. It typically happens in your 20s. They’re less likely to develop as you age. A Bartholin’s cyst develops when the duct exiting the Bartholin’s gland becomes blocked. The fluid produced by the gland then accumulates, causing the gland to swell and form a cyst. An abscess occurs when a cyst becomes infected.

Bartholin’s abscesses can be caused by any of a number of bacteria. These include bacterial organisms that cause sexually transmitted diseases such as chlamydia and gonorrhea as well as bacteria normally found in the intestinal tract, such as Escherichia coli. It is common for these abscesses to involve more than one type of organism.

Experts believe that the cause of a Bartholin’s cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps caused by infection or injury. A Bartholin’s cyst can become infected, forming an abscess. A number of bacteria may cause the infection, including Escherichia coli (E. coli) and bacteria that cause sexually transmitted infections such as gonorrhea and chlamydia.

The Bartholin’s glands, also known as the major vestibular glands, are a pair of glands between the vagina and the vulva that produce lubrication when stimulated.

Along with the lesser vestibular glands, they aid in sexual intercourse by reducing friction. The lubricating fluid goes from the Bartholin’s glands down tiny tubes (ducts) which are about 0.8 inches (2cm) long into the lower part of the entrance to the vagina.

If there is a blockage in these ducts, the lubricant builds up. The ducts expand and a cyst is formed. This is a Bartholin’s cyst. When the cyst is formed, there is a risk of infection in the area, and a subsequent abscess.

A woman is more likely to have a Bartholin gland cyst when she is:

  • young and sexually active
  • has not yet become pregnant
  • has just had one pregnancy

Cysts can range in size from that of a lentil to a golf ball. Although Bartholin’s cysts are not sexually transmitted, gonorrhea (a sexually transmitted disease) is a common cause. A cyst is a closed sac-like structure full of liquid, which can be semisolid or include gas. A bacterial infection may cause the blockage and subsequent cyst.

Examples include:

  • gonococcus, which causes gonorrhea
  • Chlamydia trachomatis, which causes chlamydia
  • Escherichia coli, which can affect water supply and cause hemorrhagic colitis
  • Streptococcus pneumonia, which can cause pneumonia and middle ear infections

Haemophilus influenzae (HIB), which can cause ear infections, and respiratory infections

Most of the time, Bartholin’s gland cysts are not infected. In some cases, they can be caused by an infection. Other times, they may become infected. Your doctor may want to check the fluid in the cyst. Most infected cysts (called abscesses) contain the normal bacteria (also called germs) that are found on your skin. Some infected cysts are caused by bacteria that are transmitted sexually.

Symptoms

You may not have any, unless the cyst is large or becomes infected. If infection sets in (doctors call this an “abscess”), you’ll likely have extreme pain at the site of the cyst. Sex — and even walking — may hurt. If the cyst is large, it can make one side of your labia majora (the large folds of skin on the outside of your vagina) hang lower than the other.

You might also have fever and an unusual vaginal discharge.

A Bartholin’s cyst causes swelling of the labia on one side, near the entrance to the vagina. A cyst is usually not very painful, and significant pain suggests that an abscess has developed. However, large cysts may be painful simply by virtue of their size.

A Bartholin’s abscess causes significant pain in addition to the swelling. The swollen area is extremely tender and the skin reddened. Walking and sitting may be quite painful.

Women with Bartholin’s abscesses do not usually have fever. Vaginal discharge may be present, especially if the infection is caused by a sexually transmitted organism.

Most Bartholin’s cysts do not cause any symptoms, although some may cause pain during walking, sitting,[2] or sexual intercourse (dyspareunia). 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.

If you have a small, noninfected Bartholin’s cyst, you may not notice it. If the cyst grows, you might feel a lump or mass near your vaginal opening. Although a cyst is usually painless, it can be tender.

A full-blown infection of a Bartholin’s cyst can occur in a matter of days. If the cyst becomes infected, you may experience:

  • A tender, painful lump near the vaginal opening
  • Discomfort while walking or sitting
  • Pain during intercourse
  • Fever

A Bartholin’s cyst or abscess typically occurs on only one side of the vaginal opening.

Most Bartholin cysts do not cause any symptoms. But if cysts become large, they can cause discomfort during sitting, walking, or sexual intercourse. Women may notice a painless lump near the opening of the vagina, making the vulva look lopsided.

Abscesses cause severe pain and sometimes fever. They are tender to the touch. The skin over them appears red. Women may have a discharge from the vagina, which is usually unrelated to the abscess.

A Bartholin’s abscess usually causes a lump to form under the skin on one side of the vagina. It’s common for a Bartholin’s abscess to cause pain during any activity that puts pressure on the area, such as walking, sitting down, or sexual intercourse.

A fever may also accompany the abscess. The area where the abscess has formed will likely be red, swollen, and warm to the touch.

You may notice a round bulge in one of your vaginal lips, near the opening of the vagina. It may be painless or slightly tender. It may stay the same size or may slowly grow larger. Cysts that get infected are usually very tender. In more severe cases, walking or sexual intercourse may be painful. Your doctor will look at the area to see if you have a cyst and to find out whether it’s infected.

Treatment

If your exam shows that you have an STI, or if your cyst is infected, your doctor will prescribe an antibiotic. He may also prescribe topical medications.If you’re under 40 and your cyst isn’t causing problems, you probably won’t need treatment. A simple sitz bath may help the cyst go away on its own. Simply fill a tub with 3 to 4 inches of water (enough to cover your vulva), and gently sit. Do this several times a day for three or four days. The cyst may burst and drain on its own.

For a small Bartholin’s cyst that is not too painful, treatment consists of sitz baths with follow-up if the cyst enlarges or becomes painful.

Especially with recurrent cysts treatment with antibiotics and sitz baths to cool off the infection is sometimes done. If this clears up the infection, a surgical procedure called a marsupialization can be done later.

Treatment may not be necessary when Bartholin’s cysts cause no symptoms. 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, for the achievement of absence of swelling and discomfort and the appearance of a freely draining duct.

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. 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, 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.

If the cyst is small and presents no symptoms, the doctor may recommend no treatment, but the patient will be asked to report any growth in the size of the cyst. Any lump in the vaginal area should be reported, especially if the patient has started the menopause.

If treatment is offered, the doctor may prescribe antibiotics.

Sometimes minor surgery is recommended.

This will involve:

  • inserting a catheter into the cyst
  • inflating the catheter to fix it in place
  • leaving the catheter for 2 to 4 weeks, to allow the fluid to drain by the catheter, and a normal opening to form

Treatment depends on the size of the cyst, how painful it is, if it’s infected, and your age. You can often treat small cysts by soaking in a few inches of warm water (called a sitz bath) several times a day for 3 or 4 days. This allows the cyst to rupture and drain with little pain or discomfort. In other cases, the doctor can perform a minor procedure in the office. During this procedure, the doctor makes an incision and puts a small tube (called a catheter) into the cyst. The catheter stays in place for 4 to 6 weeks, draining the fluid. While the catheter is in, you can go on with your normal activity. You should talk with your doctor about having sexual activity while the catheter is in place. Your doctor then easily removes the catheter in his or her office.

Another procedure that can also be done in the doctor’s office is making a small cut in the cyst to drain the fluid. The doctor will place stitches at the edge of the cyst to allow a small opening to form. This procedure is called a marsupialization. You may have light discharge for a few weeks. Panty liners should be all you need to use to take care of this discharge.

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