Bartholin's cyst

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked.[3] Small cysts may result in minimal or no symptoms.[1] Larger cysts may result in swelling on one side of the vagina, as well as pain during sex or walking.[3] If the cyst becomes infected, an abscess can occur, which is typically red and very painful.[2] If there are no symptoms, no treatment is needed.[2][3] Bartholin's cysts affect about 2% of women at some point in their life.[2] They most commonly occur during childbearing years.[2]

Bartholin's cyst
Other namesBartholin duct cyst, Bartholin gland cyst, cyst of Bartholin gland[1]
Bartholin's cyst of the right side
SpecialtyGynecology
SymptomsSwelling of one side of the vagina, pain, sometimes no symptoms[1]
ComplicationsAbscess[2]
Usual onsetChildbearing age[2]
CausesUnknown[3]
Diagnostic methodBased on symptoms and examination[3]
Differential diagnosisSebaceous cyst, hernia, hidradenitis suppurativa, folliculitis, vulvar cancer[4][5]
TreatmentPlacement of a Word catheter, incision and drainage, marsupialization, sitz baths[4][3]
Frequency2% of women[2]

When the cyst becomes uncomfortable or painful, drainage is recommended.[2] The preferred method is the insertion of a Word catheter for four weeks, as recurrence following simple incision and drainage is common.[2][4] A surgical procedure known as marsupialization may be used or, if the problems persist, the entire gland may be removed.[2] Removal is sometimes recommended in those older than 40 to ensure cancer is not present.[2] Antibiotics are not generally needed to treat a Bartholin's cyst.[2]

The cause of a Bartholin's cyst is unknown.[3] An abscess results from a bacterial infection, but it is not usually a sexually transmitted infection (STI).[6] Rarely, gonorrhea may be involved.[3][5] Diagnosis is typically based on symptoms and examination.[3] In women over the age of 40, a tissue biopsy is often recommended to rule out cancer.[4][3]

The cyst is named after Caspar Bartholin who accurately described the glands in 1677.[7] The underlying mechanism of the cyst was determined in 1967 by 20th Century obstetrician Samuel Buford Word.[8][7][9]

Signs and symptoms

Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[2] or sexual intercourse (dyspareunia).[10] They are usually between 1 and 4 cm, and are located just medial to the labia minora. Most Bartholin's cysts only affect the left or the right side (unilateral). While small cysts are usually not painful, larger cysts can cause significant pain.

Pathophysiology

A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked.[10] Blockage may be caused by an infection or a mucus plug.[10] The secretions from the Bartholin's gland are retained, forming a cyst.[2]

Diagnosis

Other conditions that may present similarly include hidradenoma papilliferum, lipomas, epidermoid cysts and Skene's duct cysts, among others conditions.[2] In women who are more than 40 years, a biopsy may be recommended to rule out cancer.[2]

Treatment

If the Bartholin's cysts is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. 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.[11]

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.[2] The balloon is then inflated to keep it in place. The catheter stays in place for 2 to 4 weeks, draining the fluid and causing a normal gland opening to form, after which the catheter is removed.[12] The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.[13]

Cysts may also be opened permanently, a procedure called marsupialization,[14] which involves opening the gland through an incision to ensure that the secretion channel remains open. If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Nonprescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort and reduce pain. Warm compresses can also speed up healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.

Prognosis

While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgical or laser 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. Many women who have marsupialization done find that the recurrences may slow, but do not actually stop.

Epidemiology

Two percent of women will have a Bartholin's gland cyst at some point in their lives.[2] 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.[15] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter.[15] Hispanic women may be more often affected than white women and black women.[2] The risk of developing a Bartholin's gland cyst increases with the number of childbirths.[2]

References
  1. WHO Classification of Tumours Editorial Board, ed. (2020). "10. Tumours of the vulva: Bartholin gland cyst". Female genital tumours: WHO Classification of Tumours. Vol. 4 (5th ed.). Lyon (France): International Agency for Research on Cancer. p. 440. ISBN 978-92-832-4504-9.
  2. Omole, Folashade; Simmons, Barbara J.; Hacker Yolanda (2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–40. PMID 12887119.
  3. "Bartholin Gland Cysts". Merck Manuals Professional Edition. Retrieved 12 September 2018.
  4. Lee, MY; Dalpiaz, A; Schwamb, R; Miao, Y; Waltzer, W; Khan, A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–5. doi:10.1159/000365683. PMC 4483306. PMID 26195958.
  5. Ferri, Fred (2017). Ferri's clinical advisor 2018 : 5 books in 1. Elsevier Canada. p. 175. ISBN 978-0323280495.
  6. Marx, John A. Marx (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN 978-1455706051.
  7. Knaus, John V.; Isaacs, John H. (2012). Office Gynecology: Advanced Management Concepts. Springer Science & Business Media. p. 266. ISBN 9781461243403.
  8. Baskett, Thomas F (2019). Mr. United Kingdom: Cambridge University Press. pp. 455–457. ISBN 978-1108421706.
  9. Williams Gynecology (2 ed.). McGraw Hill Professional. 2012. p. 1063. ISBN 9780071804653.
  10. Eilber, Karyn Schlunt; Raz, Shlomo (September 2003). "Benign Cystic Lesions of the Vagina: A Literature Review". The Journal of Urology. 170 (3): 717–722. doi:10.1097/01.ju.0000062543.99821.a2. PMID 12913681.
  11. Bartholin's cyst from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013
  12. Bourne, Tom (2007). "Mr". Australian and New Zealand Journal of Obstetrics & Gynaecology. 47: 137–140 – via Academia.edu.
  13. Reif, P; Elsayed, H (2015). "Quality of life and sexual activity during treatment of Bartholin's cyst or abscess with a Word catheter". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 190: 76–80. doi:10.1016/j.ejogrb.2015.03.008. PMID 25800788.
  14. Haider Z, Condous G, Kirk E, Mukri F, Bourne T (April 2007). "The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study". Aust N Z J Obstet Gynaecol. 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID 17355304. S2CID 36752877.
  15. Yuk, Jin-Sung; Kim, Yong-Jin; Hur, Jun-Young; Shin, Jung-Ho (2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International Journal of Gynecology & Obstetrics. 122 (1): 62–4. doi:10.1016/j.ijgo.2013.02.014. PMID 23618035. S2CID 23981470.
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