Bartholin Cyst

A Bartholin cyst refers to the enlargement of one of the Bartholin glands located on either side of the vaginal opening. The Bartholin glands, also known as the greater vestibular glands, are a pair of small excreting glands that produce a mucus-like fluid that acts as lubrication of the vaginal opening during sexual intercourse. When the ducts of these glands become obstructed, fluid can back up and form a Bartholin cyst, causing a palpable lump near the vaginal opening. 

Sometimes, the obstructed Bartholin duct can become infected and form an abscess, leading to pain around the vaginal opening, pain during intercourse, discomfort while walking, as well as fever. One thing to note is that abscesses are not always preceded by cysts, and they occur three times more often. 

Bartholin cysts are caused by the obstruction of one of the Bartholin glands. Blockage in the drainage of the gland leads to the accumulation of the fluid, which builds up over time, causing a cystic dilation of the gland. The reason why a Bartholin duct may become blocked is not clear, however, they are more likely to occur in sexually active individuals due to the friction caused by sexual intercourse. Additional risk factors include sexually transmitted infections, such as chlamydia or gonorrhea, urinary tract infections, and trauma to the genital area, such as during childbirth or an episiotomy performed after a vaginal delivery.  

While Bartholin cysts can occur at any age, they are more common among individuals between 20 and 30 years old. Enlargement of the Bartholin gland in individuals over 40 years old should raise suspicion for malignancy, especially if the gland is fixed, firm, or shaped irregularly.  

Treatment for a Bartholin cyst varies depending on the severity of symptoms and size of the cyst. Conservative measures, such as warm water soaks or sitz baths, can provide symptomatic relief in mild cases and are the first line of treatment in most cases.   

If the cyst is large or painful, a clinician may perform a simple drainage procedure. Drainage is typically performed by creating a small incision within the cyst to allow the collected fluid to drain. A flexible silicone tube called Word catheter may be inserted into the cyst to help prevent recurrence by keeping the cyst cavity open. The catheter is usually left in place for several days to weeks, depending on the size of the cyst and the amount of fluid being drained. 

In cases of recurrence, a marsupialization procedure may be performed by a gynecologist. This procedure involves creating a small permanent opening in the cyst wall to allow continuous drainage and prevent re-accumulation of fluid. In rare cases, if cysts are persistent and troublesome, surgical removal of the Bartholin gland may be considered. 

Pregnant individuals with Bartholin cysts should be treated in the same way as non-pregnant individuals, with the exception of Bartholin gland excision, which should be avoided due to pregnant individuals’ increased risk of bleeding.  

Because of the presence of other lubricating glands in the vaginal opening, removal of a Bartholin gland does not affect lubrication during sexual intercourse.   

In cases of Bartholin abscesses, or when an underlying infection is suspected, antibiotic treatment (e.g., clindamycin, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole) may also be prescribed.