Bartholin’s cyst

Introduction

A Bartholin’s cyst, also called a Bartholin’s duct cyst, is a small growth just inside the opening of a woman’s vagina. Cysts are small fluid-filled sacs that are usually harmless.

A Bartholin’s cyst can stay small and painless and may not cause any symptoms. However, the cyst can become infected, which can cause a painful collection of pus (an abscess) in the Bartholin’s gland.

What causes a Bartholin’s cyst?

The Bartholin’s glands are a pair of pea-sized glands. They are found just behind and either side of the inner lips that surround the entrance to the vagina (the labia majora). The glands are not usually noticeable because they are rarely larger than 1cm (0.4 inches) across.

The Bartholin’s glands secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes, called ducts, into the vagina. If the ducts become blocked, they will fill with fluid and expand. This then becomes a cyst.

When should I see Dr. B C Shah?

Report any new lumps to Dr. B C Shah so that he can confirm or rule out a diagnosis of a Bartholin’s cyst and check for infection or other conditions.

Also see Dr. B C Shah if you have a cyst that becomes large or painful, or is uncomfortable when you sit or walk.

Several treatments are available to treat any pain or infection and, if necessary, drain the cyst. Most treatments involve a minor surgical procedure. However, Bartholin’s cysts are known to come back in up to 38% of women.

If you do not have any symptoms, it’s unlikely that you will need treatment.

Who is affected?

According to estimates, around 2% of women will develop a Bartholin’s cyst. The condition usually affects sexually active women who are 20 to 30 years old.

The Bartholin’s glands do not start functioning until puberty, so Bartholin’s cysts do not usually affect children.

Symptoms of a Bartholin’s cyst

Most Bartholin’s cysts do not cause any symptoms. However, you may feel a soft, painless lump in your labia (the two pairs of lips that surround the entrance to your vagina).

You may not know that you have a cyst until it is found during a routine cervical screening test or another gynaecological examination.

If the cyst grows very large, it can become uncomfortable and noticeable. You may feel pain in your vulva (external sexual organs) when you walk, sit down or have sex.

Sometimes, the cyst can affect the outer pair of lips around the opening of the vagina (labia majora). One side may look swollen or bigger than usual.

Abscess

If the cyst or gland becomes infected, it can cause an abscess. This is a painful collection of pus which often gets bigger over a few hours or days.

The cyst will become swollen, tender to touch and the skin around the abscess is likely to be red and hot. An abscess can also cause a high temperature of 38C (100.4F) or above.

When to see Dr. B C Shah

See Dr. B C Shah as soon as possible if the cyst does not improve after a few days of self-care treatment. If the cyst becomes large or painful, or if there are any other symptoms such as fever or vomiting, Dr. B C Shah immediately.

If it is painful and causes discomfort when you walk or sit, it is likely that it has developed into an abscess and you will need treatment to drain the fluid.

Also visit Dr. B C Shah as soon as possible if you have symptoms such as vaginal discharge, itching or pain. You may have a sexually transmitted infection(STI).

If you have an STI, the sooner you receive treatment, the better.

Bartholin’s cyst cancer

If you notice any swelling in your vagina or any changes such as pain or itching, see Dr. B C Shah as he may need to do further tests.

In very rare cases, a Bartholin’s cyst could develop into Bartholin’s cyst cancer. It is also important for Dr. B C Shah to rule out vulval cancer.

Causes of a Bartholin’s cyst

A Bartholin’s cyst is caused by an obstruction that blocks the tube, known as a duct, which leads from the Bartholin’s gland into the vagina. This leads to a build-up of fluid, which can turn into a cyst.

Several different types of bacteria can cause an infection that blocks the duct. Some types of bacteria can be passed on through sexual contact while others are found in the environment.

The following types of bacteria may cause a Bartholin’s cyst:

Gonococcus – usually responsible for gonorrhoea (a sexually transmitted infection) and may be responsible for around a third of Bartholin’s cysts
Chlamydia trachomatis – usually responsible for chlamydia (another STI)
Escherichia coli – often responsible for food poisoning
Streptococcus pneumoniae – responsible for pneumococcal infections, such as infections of the inner ear or sinuses
Haemophilus influenzae – responsible for a number of infections such as epiglottitis, an infection of the epiglottis (the flap of tissue at the back of your throat)

As some of these bacteria are also responsible for sexually transmitted infections (STIs), such as gonorrhoea and chlamydia, you can protect yourself against them by having safer sex.

Diagnosing a Bartholin’s cyst

Dr. B C Shah can diagnose a Bartholin’s cyst with a physical examination. The symptoms and appearance of a cyst are easily recognisable.

However, if you have other symptoms, such as vaginal discharge, he may also advise that you have further tests to check for sexually transmitted infections (STIs).

Cyst biopsy

In some cases, you may be advised to have a biopsy of the cyst. A biopsy involves taking a small sample of tissue so that it can be examined under a microscope.

A biopsy may be recommended because a growth in your vulva (your external sexual organs) can be a symptom of vulval cancer.

If you notice any swelling in your vagina or any changes such as pain or itching, see Dr. B C Shah.

Treating a Bartholin’s cyst

No treatment is needed if the Bartholin’s cyst is small and is not causing any symptoms. However, women who have started the menopause are always advised to have a biopsy taken (see Diagnosis). If the cyst is causing some pain, Dr. B C Shah may advise:

Having warm baths,
Using a warm compress (cloths or cotton wool warmed with hot water) held against the area, or
Using pain relief, such as paracetemol or ibuprofen. Always read the manufacturer’s instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given aspirin.

If the cyst becomes an abscess (a painful collection of pus), you may be prescribed antibiotics to clear the infection.

Making an incision (cut) in the cyst and draining the fluid out is not recommended because the cyst will often return. There are now a number of surgical options for treating large, painful cysts and abscesses.

Balloon catheter insertion

Balloon catheter insertion is also sometimes known as word catheter placement or fistulisation.

This procedure is used to drain the fluid from the abscess or cyst and to create a fistula (passage) to drain away any future fluid that builds up. The surface of the fistula is epithelialised (new cells grow over it to heal it), but the passage remains open.

Balloon catheter insertion is carried out on an outpatient basis, which means that you will not need to stay in hospital overnight. It can be carried out under either:

Local anaesthetic, where the area is numbed so that you cannot feel anything during the procedure but you remain conscious throughout, or
General anaesthetic, where you are unconscious and unable to feel anything.

During balloon catheter insertion, an incision (cut) is made into the abscess or cyst and the fluid is drained. A specially designed balloon catheter (a thin, plastic tube with a small, inflatable balloon on one end) is inserted into the empty abscess or cyst through the incision.

The balloon is then filled with a small amount of saline solution (salt water). This increases the size of the balloon so that it fills the cyst or abscess. If you experience any pain, some of the solution can be removed from the balloon to reduce the pressure slightly.

A suture (stitch) may be used to partially close the incision and the balloon catheter is held in place in the cyst.

The catheter will stay in the incision while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon will be drained and the balloon catheter removed.

A few small studies have reported that, after balloon catheter insertion, 83-97% of women healed well and did not have any reoccurrence of cysts or abscesses.

Possible complications of balloon catheter insertion include:

Pain from having the catheter left in,
Pain during sexual intercourse,
Swelling of the labia (the fleshy lips around the opening of the vagina),
Infection,
The abscess reoccurring,
Bleeding, and
Scarring.

Alternative procedures

A number of other possible surgical procedures can be used to treat Bartholin’s cyst. These procedures are all performed under local anaesthetic, on an outpatient basis, and take around 15-20 minutes. Healing usually takes around two weeks and the possible complications are the same as those listed above.

Marsupialisation

In marsupialisation, the cyst is opened with an incision (cut) and the fluid is drained out. The edges of the skin are then stitched back together in a way that allows any further fluid build-up to continue to drain out.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals that is sometimes used in medicine, for example to cauterise (burn) the ends of blood vessels to stop them bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.

During the procedure, an incision (cut) is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).

The silver nitrate causes the cyst cavity to form into a small, solid lump. After two to three days, the piece of silver nitrate and the cyst cavity are removed or they may fall off on their own.

It is possible for the silver nitrate to burn some of the skin of your vulva on the first day that it is inserted. One small study reported that burning of the mucous membrane (the moist lining) of the vulva occurs in 20% of women.

Carbon dioxide laser

Another procedure involves using a laser to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then either be:

Removed,
Destroyed using the laser, or
Left attached, but with a hole in it.

Needle aspiration

During needle aspiration, a needle is used to drain the cyst.

Alcohol sclerotherapy

During alcohol sclerotherapy, a needle is used to drain the cyst and the cavity is filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and is then drained out.

Gland excision

Gland excision is the removal of Bartholin’s gland. The procedure can take up to an hour to complete.

Reoccurrence

The rate of reoccurrence of a cyst or abscess after one of these procedures is, on average, around 20%. One study of needle aspiration found the reoccurrence rate to be 38% and one study of marsupialisation found no reoccurrences.