What is Bartholin Gland Cyst?
The Bartholin glands, also called the greater vestibular glands, are two small (0.5 cm) glands located at the bottom parts of the vaginal opening, specifically at the areas that correlate to 4 o’clock and 8 o’clock positions. These glands secrete mucus, which helps keep the vagina lubricated. Normally, you can’t feel these glands unless they’re blocked. After puberty begins, it’s common to find cysts or abscesses in these glands. However, this happens less frequently after menopause.
What Causes Bartholin Gland Cyst?
A Bartholin gland cyst is a harmless blockage of the Bartholin gland. It generally affects only one side, produces no symptoms, and often it’s discovered incidentally during a pelvic exam or through imaging studies. The blockage of the Bartholin gland can happen after an injury to the area, an incision made to assist childbirth, or after childbirth itself. However, sometimes there seems to be no identifiable cause.
Risk Factors and Frequency for Bartholin Gland Cyst
Bartholin cysts or abscesses are mainly found in women who are of the age to have children. These cysts usually start appearing around the time a woman hits puberty and the frequency increases as she gets older, stopping at menopause. Bartholin cysts and abscesses that show symptoms make up 2% of all women’s health-related doctor visits each year.
Signs and Symptoms of Bartholin Gland Cyst
If a person is suspected to have a Bartholin gland cyst or abscess, it’s important for the doctor to ask about how long the symptoms have been present, if there is any discomfort during normal activities like walking, standing, sitting, or sexual intercourse, and whether there has been any pus-like discharge. They would also inquire about any history of Bartholin gland cysts or abscesses, vaginal discharge or irregular bleeding, and sexually transmitted infections. Bartholin cysts usually progress slowly over time and often don’t cause any symptoms. When evaluating the patient, the doctor must consider the patient’s age as rare cases of cancer can mimic these symptoms.
During the physical exam, it may be observed that one side of the lower part of the vulva might be protruding more than the other side. A significant difference between Bartholin gland cysts and abscesses is that the abscesses are very painful. Both conditions generally affect only one side, but abscesses can cause the area to become tender, red, hardened, and there may be an area that feels fluid-filled and/or a pus-like discharge.
Testing for Bartholin Gland Cyst
If there’s a chance you have a Bartholin cyst abscess, you generally won’t need many tests. However, during the process of draining the abscess, the doctor may choose to culture the wound (grow the bacteria in a lab) and perform a biopsy (examine a small piece of tissue under a microscope). If your doctor has reason to suspect sexually transmitted infections like gonorrhea or chlamydia, they may also plan for a panel of tests which specifically look for these diseases and start the suitable treatment if needed.
If the abscess looks unusual, or if you’re over 40, your doctor might suggest getting a biopsy. This is to rule out the chance of cancer. A biopsy involves taking a small sample of tissue from the abscess for examination.
Treatment Options for Bartholin Gland Cyst
If a Bartholin cyst is not causing any symptoms, no treatment is necessary. Bartholin cysts or abscesses that are draining on their own can be managed with simple home remedies like sitz baths and pain relievers.
While no single treatment method, whether surgical or non-surgical, is considered better than others in terms of preventing a recurrence, first-time Bartholin abscesses are often treated using a method called ‘incision and drainage with Word cathenter placement’. This approach is simple and effective.
It’s important to know if the patient has any allergies before starting the procedure because the Word cathenter stem is made of latex. If the patient is allergic to latex, a different procedure called ‘marsupialization’ is chosen instead.
This procedure is not fully sterile, but it’s recommended that healthcare workers wear a mask with a face shield and a gown to prevent any infection.
The incision and drainage procedure is performed by first cleaning the area with povidone-iodine and numbing the incision area with a local anesthetic. A small vertical incision of about 3 mm is made along the mucosal surface of the labia minora with a scalpel. This minimizes scarring and keeps the Word catheter snugly in place. Any discharge can be sent for lab testing, and a biopsy can also be done. The Word catheter is inserted so that the balloon tip sits inside the abscess cavity, which is then filled with saline water. The external portion of the Word catheter is tucked into the vagina for patient comfort and to reduce chances of it moving out of place. The catheter should be left in place for at least 4 weeks to allow for proper drainage and healing.
If the Bartholin abscess comes back, the same procedure can be repeated with the addition of antibiotics. These antibiotics should be able to fight bacteria like Staphylococcus aureus, streptococcal species and Escherichia coli. Antibiotics such as trimethoprim-sulfamethoxazole alone, amoxicillin-clavulanate plus clindamycin, or cefixime plus clindamycin are common choices. For recurring abscesses, patients might be referred to a gynecologist for a procedure called ‘marsupialization’.
Antibiotics might also be necessary for patients who didn’t get better with the initial treatment, have fever or symptoms of sepsis, or are at high risk for recurrence.
‘Marsupialization’ is usually done in the operating room by a gynecologist. It involves making a small incision, then flipping the edges of the cut and stitching them onto the skin surface. The Word catheter method is typically tried first because it is simpler and doesn’t require a trip to the operating room.
Other less common treatments include silver nitrate ablation, carbon dioxide laser vaporization, Jacobi ring placement, and in cases where other methods have failed, Bartholin gland excision.
Pregnant women with Bartholin abscesses should be treated in the same way as non-pregnant women. The only exception is that the Bartholin gland should not be removed due to an increased risk of bleeding.
What else can Bartholin Gland Cyst be?
There are several health conditions that could be mistaken for each other because they cause similar symptoms. These include:
- Different types of cysts, such as inclusion, Gartner, Skene, sebaceous, and canal of Nuck cysts
- Vaginal prolapse, a condition where the structures supporting the vagina weaken or break
- Vulvar angiomyofibroblastoma, a rare type of tumor
- Endometriosis, a condition where tissue similar to the lining of the uterus grows outside of it
- Choriocarcinoma, a fast-growing cancer that occurs in a woman’s uterus
- Myeloid sarcoma, a tumor of immature white blood cells
- Perineal leiomyoma, a benign tumor of smooth muscle tissue
- Myxoid leiomyosarcoma, a rare type of cancer that forms in soft tissues
- Fibroma, a benign tumor made up of fibrous or connective tissue
- Angiomyxoma, a slow-growing tumor of the female genital tract
- Hematoma, a collection of clotted or partially clotted blood
- Myoblastoma, a benign tumor of muscle cells
- Ischiorectal abscess, an infection in the space around the anal canal
- Folliculitis, inflamed hair follicles
- Fibroadenoma, a benign breast tumor
- Lipoma, a benign fatty lump
- Papillary hidradenoma, a benign skin tumor
- Syringoma, a harmless skin bump
- Adenocarcinoma, a type of cancer that starts in mucus-producing glands
- Squamous cell carcinoma, a common type of skin cancer
Every one of these conditions requires a different treatment approach, so correct diagnosis is crucial.
What to expect with Bartholin Gland Cyst
The outlook is generally very good, but if the cyst is merely drained, it has been reported to reappear frequently. The rates of healing and reoccurrence are similar across different treatment methods such as fistulization, marsupialization, and silver nitrate and alcohol sclerotherapy.
Two simple procedures, needle aspiration and incision and drainage, are not advised due to a relatively higher chance of the cyst reappearing.
Possible Complications When Diagnosed with Bartholin Gland Cyst
Bartholin’s gland cysts treatment using conventional surgery can lead to several issues and complications. These issues include bleeding, pain during sex after the operation, infections, and the need for general anesthesia. However, CO2 laser surgery could pose fewer problems. This type of surgery is considered to be less invasive and more effective, as it addresses many downsides of traditional surgery.
Recovery from Bartholin Gland Cyst
It’s highly suggested that you take sitz baths for a few days. Likewise, it’s a good idea to start moving around early and to drink plenty of water.
Preventing Bartholin Gland Cyst
Doctors, nurses, and pharmacists are key in teaching patients and their loved ones about their health conditions. They will explain to women to watch for any signs of infection like an odd-smelling vaginal discharge or unusual bleeding. They also recommend that women drink plenty of water and start moving around as soon as possible since this can help speed up their recovery process.
