What Is It, Causes, and More
Author:Nikol Natalia Armata
Editors:Alyssa Haag,Ian Mannarino, MD
Copyeditor:David G. Walker
What is a Bartholin cyst?
A Bartholin cyst refers to a benign enlargement of the Bartholin gland. The Bartholin glands, also known as the greater vestibular glands, are a pair of small excreting glands that produce mucus-like fluid. This fluid drains through a duct at the lower vestibule, acting as lubrication of the vaginal opening during sexual intercourse. When the ducts of these glands are obstructed, fluid can back up and form a Bartholin cyst. Bartholin glands are generally nonpalpable when patent (i.e. not obstructed).A Bartholin cyst is mostly diagnosed in individuals assigned female at birth that have female external genitalia at reproductive age. It usually occurs unilaterally in the lower right or left part of the vulvar vestibule (i.e., the area between the labia minora). Most often, Bartholin gland cysts are asymptomatic and are usually incidentally identified after physical examination performed by a healthcare professional. The cyst is typically filled with nonpurulent fluid that may contain microorganisms of the genital flora, such as staphylococcus, streptococcus, and E.coli. However, a Bartholin cyst can get infected with other pathogens, resulting in what is called a Bartholin abscess.
What causes a Bartholin cyst?
Bartholin gland cysts are commonly caused by the obstruction of the Bartholin gland’s ductal region. Blockage in the draining path of the gland leads to the accumulation of the secreted fluid, which builds up over time, thereby causing a cystic dilation of the gland. The exact cause of obstruction may not always be known, but it is commonly associated with infections, like sexually transmitted infections (STIs) (e.g., chlamydia, gonorrhea); other bacterial infections (e.g., E. coli); or trauma (e.g., during childbirth, episiotomy after a vaginal delivery).
What does a Bartholin cyst look like?
The presentation of a Bartholin cyst may vary depending on its size and location. Bartholin cysts are easily identified upon physical examination as growths that protrude unilaterally at the lower part of the vestibule. Non-painful swelling of the labia majora may also be evident on the affected side. Cysts that are larger in size can be accompanied by additional signs and symptoms, like tenderness during walking, sitting, or intercourse; urinary irritation; vague pelvic pain; and vaginal discharge, especially when associated with an STI. Fever, redness, and intense pain in the surrounding area of the vagina (i.e., vulva) are usually present in individuals with an inflamed Bartholin cyst.
How is a Bartholin cyst diagnosed?
A Bartholin cyst is diagnosed after a thorough review of symptoms, medical history, and physical examination. They typically do not require further laboratory or imaging studies. However, when medical intervention is required, cultures and biopsies of the cyst may be taken. If sexually transmitted infections are suspected as the underlying cause of the Bartholin cyst, thorough STI testing (e.g., gonorrhea and chlamydia) should be performed in order to initiate appropriate treatment as soon as possible.
How is a Bartholin cyst treated?
Treatment for a Bartholin cyst varies depending on the severity of symptoms and pattern of disease. Medical interventions are typically required only when symptoms are significant; however, conservative measures, such as warm water soaks or sitz baths, can provide symptomatic relief.
The most common intervention for a Bartholin cyst is incision and drainage (I&D) of the cyst with a Word catheter in which a small incision is made in the cyst, releasing the entrapped fluid and preventing further infections. If the cyst is infected or infection is suspected, incision and drainage is necessary in order to remove the pus. Word catheters should be kept in the cyst for at least four weeks to drain the cyst appropriately and allow epithelialization (i.e., migration of epithelial cells to repair a wounded area). Incision and drainage with catheter placement may be re-attempted for recurrent Bartholin cysts. Additional antibiotic therapy should be considered for individuals who have recurrent Bartholin cysts despite initial drainage; individuals with systemic symptoms, including fever; and those considered at high risk for recurrence.
Antibiotics can be given if bacterial infection is suspected and should cover staphylococci (specifically methicillin-resistant Staphylococcus aureus [MRSA]); streptococci; and enteric gram-negative aerobes, like Escherichia coli. Therefore, commonly prescribed antibiotics include trimethoprim-sulfamethoxazole or clindamycin with either amoxicillin-clavulanate or cefixime.
In severe cases with high recurrence, cyst marsupialization can be performed by a gynecologist in which the edges of the incision are sutured together to form a permanently open "pocket," allowing additional fluid to drain freely. When the aforementioned treatment options have been proven ineffective, surgical removal of the cyst is an effective treatment option. After surgery, the wound may be left open and packed with gauze or may be closed with stitches. The incision must remain clean, dry, and free of hair until fully healed.Pregnant individuals with Bartholin cysts should be treated in the same way as nonpregnant individuals, with the exception of Bartholin gland excision, which should be avoided due to pregnant individuals’ increased risk of bleeding.
What are the most important facts to know about Bartholin cyst?
Bartholin cysts refer to the benign cystic dilation of the Bartholin glands that develop frequently in individuals assigned female at birth during their reproductive age. They are mainly caused by obstruction of the gland’s duct, which can be associated with infections (e.g., STIs) or trauma. Usually, Bartholin gland cysts are asymptomatic or associated with mild symptoms, like swelling and tenderness of lower vulvar vestibule, which worsens when infected. Diagnosis occurs after a thorough review of medical history and physical examination. Medical interventions are typically required only when symptoms are significant and include incision and drainage of the cyst with a Word catheter, cyst marsupialization, surgical removal of the cyst, and additional antibiotic therapy.
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Resources for research and reference
Lee, M. Y., Dalpiaz, A., Schwamb, R., Miao, Y., Waltzer, W., & Khan, A. (2015). Clinical Pathology of Bartholin's Glands: A Review of the Literature. Current Urology, 8(1): 22–25. DOI: 10.1159/000365683
Lee, W.A., & Wittler, M. (2021). Bartholin Gland Cyst. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532271/Omole, F., Kelsey, R. C., Phillips, K., & Cunningham, K. (2019, June 15). Bartholin duct cyst and gland abscess: Office management. American Family Physician, 99(12): 760-766. Retrieved November 27, 2021, from https://www.aafp.org/afp/2019/0615/p760.html.