Bartholin's cyst
A Bartholin's cyst occurs when Bartholin's gland, within the labia, becomes blocked.[1] Small cysts may result in few symptoms.[1] Large cysts may result in swelling of one side of the vagina, and pain with sex or walking.[1] If the cyst becomes infected an abscess occurs.[2] These are typically red and very painful.[2]
| Bartholin's cyst | |
|---|---|
| Other names | Bartholinitis, Bartholin's duct cyst, Bartholin's abscess |
 | |
| Bartholin's cyst of the right side | |
| Specialty | Gynecology |
| Symptoms | Swelling of one side of the vagina, pain[1] |
| Complications | Abscess[2] |
| Usual onset | Childbearing age[2] |
| Causes | Typically unknown[1] |
| Diagnostic method | Based on symptoms and examination[1] |
| Differential diagnosis | Sebaceous cyst, hernia, hidradenitis suppurativa, folliculitis, vulvar cancer[3][4] |
| Treatment | Placement of a Word catheter, incision and drainage, marsupialization, sitz baths[3][1] |
| Frequency | 2% of women[2] |
The cause is typically unknown.[1] With an abscess, a bacterial infection has occurred, but it is not usually a sexually transmitted infection (STI).[5] Rarely gonorrhea may be involved.[1][4] Diagnosis is typically based on symptoms and examination.[1] In those over the age of 40, a tissue biopsy is recommended to rule out cancer.[3][1]
If there are no symptoms, no treatment is typically needed.[2][1] In those with symptoms, drainage is recommended.[2] The preferred method is the insertion of a Word catheter for four weeks, as recurrence following simple incision and drainage is common.[2][3] A surgical procedure known as marsupialization may be used or, if the problems persist, the entire gland may be removed.[2] Removal is sometimes recommended in those older than 40 to ensure cancer is not present.[2] Antibiotics are not generally needed.[2]
Bartholin's cysts affect about two percent of women at some point in their life.[2] They most commonly occur during the childbearing years.[2] The disease is named after Caspar Bartholin who accurately described the glands in 1677.[6] The underlying mechanism of the disease was determined in 1967 by Buford Word.[6][7]
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).[8] 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.[8] Blockage may be caused by an infection or a mucus plug.[8] 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 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.[9]
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,[10] 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.[11] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter.[11] 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
- "Bartholin Gland Cysts". Merck Manuals Professional Edition. Retrieved 12 September 2018.
- Omole, Folashade; Simmons, Barbara J.; Hacker Yolanda (2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–40. PMID 12887119.
- Lee, MY; Dalpiaz, A; Schwamb, R; Miao, Y; Waltzer, W; Khan, A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–5. doi:10.1159/000365683. PMC 4483306. PMID 26195958.
- Ferri, Fred (2017). Ferri's clinical advisor 2018 : 5 books in 1. Elsevier Canada. p. 175. ISBN 978-0323280495.
- Marx, John A. Marx (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN 1455706051.
- Knaus, John V.; Isaacs, John H. (2012). Office Gynecology: Advanced Management Concepts. Springer Science & Business Media. p. 266. ISBN 9781461243403.
- Williams Gynecology (2 ed.). McGraw Hill Professional. 2012. p. 1063. ISBN 9780071804653.
- Eilber, Karyn Schlunt; Raz, Shlomo (September 2003). "Benign Cystic Lesions of the Vagina: A Literature Review". The Journal of Urology. 170 (3): 717–722. doi:10.1097/01.ju.0000062543.99821.a2. PMID 12913681.
- Bartholin's cyst from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013
- Haider Z, Condous G, Kirk E, Mukri F, Bourne T (April 2007). "The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study". Aust N Z J Obstet Gynaecol. 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID 17355304.
- Yuk, Jin-Sung; Kim, Yong-Jin; Hur, Jun-Young; Shin, Jung-Ho (2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International Journal of Gynecology & Obstetrics. 122 (1): 62–4. doi:10.1016/j.ijgo.2013.02.014. PMID 23618035.