Bartholin’s Cyst - Symptoms, Causes, Treatment, Prevention

Bartholin's cyst meaning

A Bartholin's cyst also called a Bartholin's duct cyst, characterized by the presence of a small fluid-filled sac just inside the opening of the vagina and appears as a soft, painless lump occurring at one side of the vagina (unilateral). In some cases, these cysts may become enlarge (noticeable) and painful. Bartholin's cyst can also develop into abscess in case of bacteria or any other microorganisms.

Bartholin’s cyst is formed in the Bartholin glands. These glands are round, very small, nonpalpable, and located on either side of the entrance to the vagina and produces and secrets mucus (fluid) to help the vagina stay moist (provide lubrication). Tiny tubes called ducts transport fluid downwards. A blockage or obstruction of the duct could occur due to oedema, infection, or trauma, leading to mucus build-up, which dilates the duct, resulting in cysts or abscesses.

Bartholin's cyst prevalence

The most common types of Bartholin gland masses are either cysts or abscesses. However, abscesses are three times more common than cysts. Symptomatic patients suffering from Bartholin cysts and abscesses account for approximately 2% of all gynaecologic visits per year, indicating 1 in 50 females may develop a Bartholin's cyst or abscess for reasons that are unclear (unknown). 

Generally, these females are sexually active and range in between 20 and 30 years of age. Bartholin's cysts don't usually affect children and females above menopause age because Bartholin's glands functioning starts from puberty. Due to the shrinkage of the glands, after menopause, the condition is rarely seen. However, Bartholin's cysts/abscesses may occur at any age of a woman.

Bartholin’s cyst causes

The following are the common reasons for Bartholin's cysts and abscesses:

Bartholin's cyst:

• Blockage: Bartholin gland cyst occurs when the ducts of the glands that carry fluid from the glands gets blocked, and the fluid (mucus) builds up, causing cyst. A woman may feel quite dry in the vagina due to absence of lubrication.

        An obstruction is often caused by local or diffuse vulvar oedema (widespread swelling of the tissues          around the vulva), trauma to the area, episiotomy (an incision through the region (perineum)                      between a women's vaginal opening and anus), or childbirth. However, it may also happen without            any identifiable cause.

Bartholin's abscess: An obstructed Bartholin duct can become infected and form an abscess.

• Infection: It's often not clear (unknown) why the ducts become blocked or obstructed, but some cases are linked to local infection, sexually transmitted infections, or an injury to the vulval area that can cause blockage and infection of the gland. The following are the microbes which may cause the abscess:
  
• Single or polymicrobial opportunistic organisms may cause Bartholin's gland abscesses. Most common isolates are Escherichia coli, and Staphylococcus aureus.
• Respiratory organisms, including Streptococcus pneumoniae and Haemophilus influenzae, are becoming more common, possibly due to the practice of oral sex.
• Sexually transmitted infections are responsible for only a small number of cases.

Vulvovaginal surgery: It is a rare cause of these cysts and abscesses.

Bartholin's cyst symptoms

Many Bartholin's cysts don't cause noticeable symptoms. However, usually, they are discovered when a woman detects a tiny, painless mass just outside the opening to the vagina because Bartholin's glands are palpable (feels) only if the duct becomes cystic or a gland abscess develops or when a gynaecologist notices it during a routine pelvic examination. The following are the common symptoms that will be observed in patients who have Bartholin cysts and abscesses:

Bartholin's cysts:

• Labial swelling:  Painless, one-sided swelling of the labia (one of the skin folds of the vulva) mass without signs of surrounding cellulitis (inflammation of the surrounding tissue). Sometimes, the cyst affects the labia majora (outer pair of lips surrounding the vagina). One side may look swollen or bigger than usual.
• Discomfort or pain: However, if this cyst grows larger than 1 inch in diameter (large Bartholin cyst), discomfort or pain may be observed when pressure is applied while the patient is sitting or walking. 
• Nonpurulent (no pus) discharge from a ruptured cyst.
• Vaginal dryness 

Bartholin's abscesses:

• Presence of lump: A tender lump (painful sensation when touching it) on one side of the vagina where the ducts are situated.
• Smelly discharge: If a cyst becomes infected, it may fill with pus and become firm, swollen, and painful; the pus-filled cyst is known as abscess. Pus may begin to ooze from the area (abscess) and foul smell. It can increase temperatures up to 38°C (100.4°F) or above.
• Fever: Fever is uncommon in healthy patients. However, fever with other symptoms indicates infection.
• Redness and swelling: The area may look red, swollen and hot to touch
• Pain during intercourse: Patients may experience pain during sexual intercourse
• Stinging sensation: Patient may find it uncomfortable to pass urine 

Sudden relief from symptoms may occur if the lump in the vulva drains or bursts on its own.

Bartholin's cyst risk factors

Risk factors associated with the development of a Bartholin's cyst and abscess includes:

• Nulliparity (haven’t had any baby)
• Sexually active women under the age of 40
• A previous Bartholin's cyst or abscess is a risk factor for recurrence. 
• Previous history of vulval surgery or trauma, including female genital mutilation
• Abscesses are commonly caused by polymicrobial organisms, including Escherichia coli, Staphylococcus aureus, and sexually transmitted organisms such as Gonorrhoea.
• Diabetics are more prone to abscesses.
  

Bartholin's cyst complications

Complications of Bartholin's cyst could be interlapped with Bartholin's abscess. The following are the possible complications of Bartholin's cyst and abscess:

Bartholin's cyst complications:

• Rectovaginal fistula (abnormal connection between vagina and rectum)
• Hydroureteronephrosis usually in neonates (dilation or (swelling) of ureter and the kidney resulting from the blockage of the urinary tract)
• Sepsis (body's overactive and extreme response to an already existing infection)
• Reoccurrence 

Bartholin's abscess complications:

• Rectovaginal fistula and sepsis 
• Reoccurrence
  

Bartholin gland cyst diagnosis

The diagnosis of a Bartholin gland cyst or abscess is usually made by examination of the vulva. A gynecologists' may ask about the symptoms before physically inspection of the area. The following are the tests that would be recommended to diagnose Bartholin's cysts or abscesses:

• Physical examination: Physical examination includes visual inspection and palpation of the Bartholin gland. They may perform a pelvic exam by touching; if the patient presents with a cyst or abscess, they may clinically present as follows:
• Cyst: Painless, soft mass near the back of the vaginal opening at the site where the Bartholin duct and gland located.
• Abscess: A painful, warm, or pus-filled lump at the location of the Bartholin duct and gland, often surrounded by redness and inflammation (swelling).
• Abscess cultures: Gynaecologists send samples of vaginal discharge to look out for any infection. If purulent (pus) discharge is present, it will send to find the bacteria.
• Biopsy: Biopsy is recommended in a woman over 40 years of age or postmenopausal women. For patients of any age with suspicion of malignancy of the Bartholin gland or other vulvar site, a biopsy is also suggested.
  

If the Bartholin’s cyst is not causing pain or discomfort, treatment may not be required. However, some cysts can be managed by following the simple methods at home, where these methods are helpful to manage the pain and even make a cyst open and drain by itself:

• Sitz bath (warm water bath used for healing or cleansing purposes)
• Warm compress
• Painkillers

A gynaecologist may choose the treatment depending on the Bartholin's cyst size, how painful it is, and the presence of infection. Treatment options include the following:

• Antibiotics
• Drainage
• Surgery
• Other techniques
  

Antibiotics

If the Bartholin’s cyst becomes infected and an abscess accumulates, antibiotics will be recommended to clear the infection. 

Bartholin's cyst drainage:

Once the infection has been treated, a gynaecologist may still recommend draining the cyst, especially if the abscess is large.

• Fistulization: It is sometimes called catheter placement or balloon catheter insertion, a traditional approach for treating symptomatic cysts or abscesses, although it is not appropriate for deep cysts.

Surgery

Bartholin's cyst surgery

Bartholin cyst removal surgery (Bartholin's cyst operation) may be required to open the cyst and stitch its walls to the surrounding skin to make it open. This procedure is called marsupialisation. 

• Marsupialisation: It is appropriate for treating a primary or recurrent Bartholin duct cyst or gland abscess. Alternatively, a gynaecologist may need to remove a gland if the Bartholin cysts reoccur.

Bartholin gland removal 

Surgery is recommended to remove the affected Bartholin's gland if other treatments have not been effective, and Bartholin's cysts or abscesses recurs or if cancer is suspected.

Other techniques: 

The following are the other techniques that will be performed to treat the cysts. However, they are less commonly used or not widely available:

• Sclerotherapy: Using alcohol or silver nitrate may also be used to treat Bartholin duct cysts and gland abscesses.
• Carbon dioxide laser therapy: It includes cyst therapy, which is a safe and effective way to completely treat a Bartholin cyst.
• Silver nitrate gland ablation: As per some studies, this ablation following cyst drainage was as effective as marsupialization and caused less scar formation.
• Needle aspiration: A needle and syringe will be used to drain the Bartholin’s cyst during this process.
  

Bartholin's cyst prevention

It's not usually possible to prevent Bartholin cysts or abscesses due to lack of clarity in the development of Bartholin's cysts. Even while there is no way to prevent them totally, the following steps can help reduce the likelihood of getting these cysts or abscesses:

• Practicing safe intercourse: However, as some are thought to be linked to sexually transmitted infections (STIs), practice safe intercourse (using a condom during intercourse) can help reduce the chances of developing Bartholin's cysts. 
• Maintaining hygiene: It is recommended to keep the vulvar and vaginal area clear. 
• Surveillance: A gynaecologist also does a biopsy in the case of post-menopausal women or suspicion of malignancy to rule out cancer.