A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked.[ If the cyst becomes infected, an abscess can occur, which is typically red and very painful.]
When the cyst becomes uncomfortable or painful, drainage is recommended.
The cause of a Bartholin's cyst is unknown.
The cyst is named after Caspar Bartholin who accurately described the glands in 1677.
Signs and symptoms
Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[ or sexual intercourse (dyspareunia).]
Pathophysiology
A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked.[
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Diagnosis
Other conditions that may present similarly include hidradenoma papilliferum, , epidermoid cysts and Skene's duct cysts, among others conditions.[ In women who are more than 40 years, a biopsy may be recommended to rule out cancer.][
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Treatment
If the Bartholin's cyst is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. Sitz bath may be useful in draining minor cysts. This is a conservative treatment that involves soaking the vaginal area in a few inches of warm water. It is generally recommended to do this for ten minutes at a time, up to four times per day. This treatment can sometimes cause cysts to spontaneously drain without further intervention.
In cases that require intervention, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, to alleviate swelling and discomfort.
Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.[ The balloon is then inflated to keep it in place. A sample of purulent discharge can be sent to a lab for culturing and a biopsy may also be done.]
Cysts may also be opened permanently, a procedure called marsupialization.
Bartholin's cysts can be treated in the same way for pregnant women as non-pregnant women. The only treatment that should be used with caution in pregnant women is Bartholin gland excision (surgical removal of the gland). This is due to the increased risk for bleeding.
Prognosis
While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgery or laser surgery removal of a cyst makes it less likely that a new one will form at the same site. Those with a cyst are more likely than those without a cyst to get one in the future. They can recur every few years or more frequently.
A randomized control trial (the WoMan trial) was performed in the Netherlands and England from 2010 to 2014. Women with bartholin's cysts were randomly assigned to receive treatment via Word catheter or marsupialization to compare rate of recurrence over a 1-year period. This trial found that recurrence rates were quite similar between the two treatments. Recurrence occurred in 12% of women in the catheter group and 10% of women in the marsupialization group. They did find that the frequency of use of analgesics was greater in the marsupialization group than the catheter group.
Epidemiology
Two percent of women will have a Bartholin's gland cyst at some point in their lives.[ They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years.][ The risk of developing a Bartholin's gland cyst increases with the number of childbirths.][
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