Bartholin’s Cyst

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Bartholin’s cyst\:
Aetiology\: mucus accumulation blocks the gland; located at 4 and 8 o’clock positions in labia majora, secretes mucus for
vaginal lubrication.
Risk factors\: nulliparous women aged 20-30, history of Bartholin’s cysts, vulval surgery, sexual activity, previous vulval
trauma.
Symptoms\: asymptomatic if small; larger cysts cause vulvar pain, dyspareunia, dysuria, and possible vaginal discharge.
Examination\: unilateral labial mass, soft and
Di
carcinoma.
Investigations\: clinical diagnosis; swabs for infection; biopsy in women over 40 to rule out carcinoma.
Management\: no treatment for small/asymptomatic cysts; warm baths, antibiotics if systemically unwell; word catheter or
marsupialisation for larger cysts.
Complications\: untreated cyst can lead to infection, bacteraemia, sepsis; post-treatment complications include pain,
oedema, infection, bleeding, scarring, and recurrence.
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Introduction

A Bartholin’s cyst is a
women, typically of childbearing age.
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Bartholin’s cysts and abscesses account for approximately 2% of all annual gynaecological visits.
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Aetiology

The Bartholin’s glands (greater vestibular glands) are paired and located at the posterior aspect of the labia majora. The
gland openings are in the 4 o’clock and 8 o’clock position, on either side of the vaginal ori
function of these glands is mucus secretion, providing lubrication for the vagina. Generally, they cannot be palpated.
Cysts form when an accumulation of mucus secretions causes the gland to become blocked.Figure 1. Diagram showing female anatomy and location of Bartholin’s (greater
vestibular) glands.
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Risk factors

Women of childbearing age (between 20 and 30) who are nulliparous or of low parity are most a
There are several other risk factors to consider\:
Personal history of previous Bartholin’s cysts
History of vulval surgery
Being sexually active (some cysts or abscesses are thought to be linked to sexually transmitted infections, STIs)
Previous vulval trauma

Clinical features

History
Small cysts may be asymptomatic. However, in cases where they have become larger, typical symptoms include\:
Vulvar pain, especially when walking or sitting
Super
Rapid onset of symptoms over a few days to hours with acute pain
Di
Sudden relief of pain, which would indicate spontaneous cyst rupture
Vaginal discharge (very likely in women with bacterial infections or STIs)
It is also important to ascertain the patient's previous history of Bartholin’s cyst and whether this is becoming a recurrent
issue.
Clinical examination
When suspecting a Bartholin’s cyst, clinical examination is essential.
A unilateral labial mass will be seen. This mass will arise from the posterior aspect of the labia majora, but there will be
anterior expansion in cases where it has become signi
If left untreated, the cyst can become infected, resulting in the formation of an abscess.
During the examination, it is important to di
management\:
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Bartholin’s cyst\: non-tender, soft and
Bartholin’s abscess\: tense and Di
These di
Sebaceous cyst
Folliculitis
Lipoma
Fibroma
Haematoma
Hidradenitis suppurativa
Bartholin’s gland carcinoma
Bartholin’s gland tumour (e.g. adenoma or nodular hyperplasia)

Investigations

The diagnosis of Bartholin’s cysts is usually clinical, through bedside examination. In most cases, there is no necessity for
further investigation.
Laboratory investigations
Where appropriate (for management purposes), a swab of the cyst/abscess contents should be taken. Laboratory

In infection, aerobic organisms are the most common causative pathogens and E s c h e r i c h i a c o l i predominates.
Occasionally, organisms that cause sexually transmitted infections, such as gonorrhoea or chlamydia, may also be
cultured. Treatment regimens can then be tailored to target the identi
Biopsy
It is important to note that women over the age of 40 presenting with a Bartholin’s cyst should have a biopsy taken of
the region to rule out carcinoma.
Whilst unusual, vulval malignancies can occasionally present in this way. Carcinoma of the Bartholin’s gland itself
accounts for approximately 5% of all vulval carcinomas.
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Management

In cases where the cyst is small or asymptomatic, there is no need to initiate treatment. Warm baths can be recommended
to try to stimulate spontaneous rupture.
Medical management
Antibiotic therapy may be initiated, if necessary, with swabs and cultures taken from the cyst. Generally, this is only when
the individual is systemically unwell or immunocompromised.
Surgical management
There are two main surgical management options\: word catheter or marsupialisation.
Word catheter
Performed under local anaesthetic. A small incision is made into the cyst/ abscess, and a catheter is inserted. The
catheter tip (balloon) is in
This is then left in place for up to 4 weeks, allowing for epithelialisation of the tract that has been created. Fluid from the
cyst can drain around the catheter tubing. Once epithelialisation has occurred, the catheter can be removed.
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MarsupialisationPerformed under general anaesthesia. A small vertical incision is made into the cyst behind the hymenal ring of the vagina,
this allows for spontaneous drainage of the cyst.
The wall of the cyst is then everted and sutured to the end of the vaginal mucosa. The cyst has been sutured open,
preventing recurrence.
Other treatment options
There are some other treatment options, although far less common and rarely used nowadays. These include\:
Silver nitrate cautery\: cyst/ abscess drained, and small stick of silver nitrate inserted into the cavity once
drained. This is left for 2/3 days at which point the contents are removed or they fall out on their own.
Carbon dioxide laser\: used to create an opening on the surface of the cyst/ abscess so the cyst can drain.
Needle aspiration\: used to drain the cyst. In some instances, alcohol sclerotherapy is used whereby the cavity is
with 70% alcohol
Generally, complete excision and removal of the gland is avoided except in instances where malignancy is suspected/
con
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Complications

Complications if Bartholin’s cyst/abscess are left untreated include\:
Spread of infection to local structures
Bacteraemia and potential sepsis
Possible complications of balloon catheter insertion include\:
Pain at the site of the catheter insertion
Pain/discomfort during sexual intercourse
Local oedema around the labia
Infection
Bleeding
Scarring
Complications post marsupialisation are rare but include\:
Infection
Cyst/abscess recurrence
Bleeding
Pain

References

Berger, M. B., Betschart, C., Khandwala, N., DeLancey, J. O., & Haefner, H. K. (2012). Incidental bartholin gland cysts identi
on pelvic magnetic resonance imaging. Obstetrics & Gynecology, 120(4), 798-802.
Marzano, D. A., & Haefner, H. K. (2004). The bartholin gland cyst\: past, present, and future. J o u r n a l o f l o w e r g e n i t a l t r a c t
d i s e a s e , 8 (3), 195-204.
R. Dewaele (Bioscope, Unige), J. Abdulcadir (HUG), C. Brockmann (Bioscope, Unige), O. Fillod, S. Valera-Kummer (DIP),
F e m a l e a n a t o m y s h o w i n g B a r t h o l i n’ s gl a n s . License\: [CC BY-SA]
Lee, W.A. (2023) B a r t h o l i n g l a n d c y s t , S t a t P e a r l s . Available from\: [LINK]
Heller, D. S., & Bean, S. (2014). Lesions of the Bartholin gland\: a review. Journal of lower genital tract disease, 18(4), 351-357.
NICE. Balloon catheter insertion for Bartholin’s cyst or abscess; NICE Interventional Procedure Guidance. Published in 2009.
Available from\: [LINK]Reviewer
Mr Michael Stephanou
Consultant Obstetrician & Gynaecologist

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Contents

Introduction
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