Bartholin's Cyst

What is a Bartholin's cyst?

A Bartholin's cyst is a fluid-filled mass that can develop near the opening of the vagina. They can be painful or painless and are caused by a buildup of fluid in a small gland near the vaginal canal.

Symptoms predominantly include the presence of a painless bump near the vaginal opening as well as pain or discomfort in the vaginal area with or without activity.

Bartholin's cysts do not routinely require treatment. Painful or disfiguring cysts can be treated using a number of different surgical options to drain or fully remove the cyst.

For small Bartholin cysts that are not bothering you, treatment is not required.

Bartholin's cyst symptoms

Many Bartholin's cysts do not cause any symptoms and may be found during a routine pelvic exam. Symptoms that Bartholin's cysts can cause include:

• Painless  Bartholin's cysts can sometimes be felt by pushing on the area between the outside of the vaginal opening and the inside of the vaginal canal. The bump may feel fluid-filled when pressed.: Bartholin cysts can sometimes be felt by pushing on the area between the outside of the vaginal opening and the inside of the vaginal canal. The bump may feel fluid-filled when pressed.
• Pain or discomfort in the vaginal area: Pain or discomfort in the vaginal area is more frequently seen with larger Bartholin's cysts, which may push on nearby structures. The area may be tender.
• Pain during sitting, walking, or sexual intercourse: This is all possible in some women who have Bartholin cysts.
• Unpleasant or disfiguring appearance: Some Bartholin's cysts may alter the appearance of the vaginal opening. This is more common with larger Bartholin's cysts, which may distort nearby structures.

Bartholin's cyst causes

The Bartholin's glands, also known as the greater vestibular glands, are two glands located on either side of the vaginal opening at the four and eight o'clock positions. The glands are connected to ducts that open to the vaginal canal and normally produce the mucus that provides lubrication. If the opening to the vaginal canal becomes blocked, such as by swollen tissues near the opening of the vagina, mucus can build up in the duct, creating a Bartholin's cyst.

Who is most likely to be affected

Bartholin's cysts are found in about three percent of women. There are no known risk factors for developing a Bartholin's cyst, although it may be more common with increasing age until menopause.

Treatment options and prevention for a Bartholin's cyst

Bartholin's cysts that do not cause any symptoms and routinely do not need to be treated. Bartholin's cysts that cause symptoms or disfigurement can usually be treated with a simple procedure in the office or emergency room.

Incision and drainage

Most Bartholin's cysts can initially be treated with an incision and drainage procedure. In this procedure, anesthesia is administered to the area, a small incision is made near the Bartholin's cyst, and the fluid inside drains spontaneously or is gently pushed out. This procedure is effective in treating the Bartholin's cyst; however, there is a high rate of cyst recurrence unless a Word catheter is placed into the cyst, as described below.

Placement of a Word catheter

A Word catheter is a latex tube with an inflatable balloon at the end. The balloon end is placed inside the drained Bartholin's cyst and then inflated, and the Word catheter is left in place for several weeks. This allows the skin to heal around the catheter, forming a "tunnel" that will remain open after the Word catheter is removed and thus preventing the Bartholin's cyst from reforming. After at least four weeks, the Word catheter can be deflated and removed in the office without anesthesia.

Marsupialization surgery

In this procedure, the Bartholin's cyst is cut open and allowed to drain like an incision and drainage, and then the sides of the cyst are sutured, leaving an opening. This allows any fluid that accumulates to directly drain through the opening and prevents the Bartholin's cyst from reforming. This procedure is usually done in the operating room for women who cannot receive a Word catheter or who have recurrent Bartholin's cysts despite receiving a Word catheter.

Laser treatment of the cyst

A carbon dioxide laser can be directed at the cyst to vaporize it. This procedure can be done in the office with local anesthesia and has good outcomes, but is generally used less often because the laser equipment and expertise required is not widely available.

Surgery to remove the entire Bartholin's gland

In rare cases of Bartholin's cysts that recur despite multiple surgeries, the Bartholin's gland can be removed. This procedure is done in the operating room and prevents the Bartholin's cyst from reforming. However, this procedure has a higher rate of complications, such as bleeding and scarring, compared to the other surgical options.

When to seek further consultation for a Bartholin's cyst

You should go see your physician if you experience a bump in the vaginal area, vaginal pain, or pain with activity. He or she can perform an examination to determine if you have a Bartholin's cyst and then offer the appropriate treatments.