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Bartholin's cystBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/bartholin-cyst/DS00667
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The Bartholin's (BAHR-toe-linz) glands are located on each side of the vaginal opening. These glands secrete fluid that helps lubricate the vagina. Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin's cyst. At times, the fluid within the cyst may become infected, resulting in pus surrounded by inflamed tissue (abscess).
A Bartholin's cyst or abscess is common. Treatment of a Bartholin's cyst depends on the size of the cyst, the pain and whether the cyst is infected. Sometimes home treatment is all you need. In other cases, surgical drainage of the Bartholin's cyst is necessary. If an infection occurs, antibiotics may be helpful to treat the infected Bartholin's cyst.
If the cyst remains small and no infection occurs, you may not notice it. If it grows, you might feel the presence of a lump or mass near your vaginal opening. Although a cyst is usually painless, it can be tender.
If the cyst becomes infected — a full-blown infection can occur in a matter of days — you may experience these signs and symptoms:
- A tender or painful lump near the vaginal opening
- Discomfort while walking or sitting
- Pain during intercourse
A cyst or abscess typically occurs on only one side of the vaginal opening.
When to see a doctor
Call your doctor if you have a painful lump near the opening of your vagina that doesn't improve after two or three days of self-care treatment — for instance, soaking the area in warm water (sitz bath). If the pain is severe, make an appointment with your doctor right away.
If you find a new lump near your vaginal opening and you're older than 40, call your doctor promptly. Although rare, such a lump may be a sign of a more serious problem, such as cancer.
Experts believe that the cause of a Bartholin's cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps by the growth of a flap of skin or because of infection.
A cyst can become infected, forming an abscess. A number of bacteria may cause the infection, including common bacteria, such as Escherichia coli (E. coli), as well as bacteria that cause sexually transmitted infections such as gonorrhea and chlamydia.
Bartholin cysts are likely to persist. Abscesses may recur and again require treatment.
Preparing for your appointment
Your first appointment will likely be with either your primary care provider or a doctor who specializes in conditions that affect women (gynecologist). Because appointments can be brief, and there's often a lot to cover, it's a good idea to be prepared.
What you can do
- Write down your symptoms, including any that seem unrelated to your condition.
- Make a list of any medications as well as vitamins or other supplements that you take.
- Take a notebook or notepad with you to write down information during your visit.
- Prepare questions to ask your doctor, listing the most important first in case time runs out.
For a Bartholin's cyst, some basic questions to ask include:
- What's likely causing my symptoms?
- What kind of tests might I need?
- Will the cyst go away on its own, or will I need treatment?
- How long should I wait after treatment before having sex?
- What self-care measures might help relieve my symptoms?
- Will the cyst come back again?
- Do you have any printed material or brochures I can take home with me? What websites do you recommend?
Don't hesitate to ask questions during your appointment if you don't understand something.
What to expect from your doctor
Some potential questions your doctor might ask include:
- How long have you been experiencing symptoms?
- How severe are your symptoms?
- Do you experience pain during sex?
- Do you experience pain during normal daily activities?
- Does anything improve your symptoms?
- Does anything make your symptoms worse?
Tests and diagnosis
To diagnose a Bartholin's cyst, your doctor may:
- Ask questions about your medical history
- Perform a pelvic exam
- Take a sample of secretions from your vagina or cervix to test for a sexually transmitted infection
- Recommend a test of the mass (biopsy) to check for cancerous cells if you're postmenopausal or over 40
If cancer is a concern, your doctor may refer you to a gynecologist who specializes in cancers of the female reproductive system.
Treatments and drugs
Often a Bartholin's cyst requires no treatment — especially if the cyst causes no signs or symptoms. When needed, treatment depends on the size of the cyst, your discomfort level and whether it's infected, which can result in an abscess.
Treatment options your doctor may recommend include:
- Sitz baths. Soaking in a tub filled with a few inches of warm water (sitz bath) several times a day for three or four days may help a small, infected cyst to rupture and drain on its own.
- Surgical drainage. You may need surgery to drain a cyst that's infected or very large. Drainage of a cyst can be done using local anesthesia or sedation. For the procedure, your doctor makes a small incision in the cyst, allows it to drain and then places a small rubber tube (catheter) in the incision. The catheter stays in place for up to six weeks to keep the opening from closing and to allow complete drainage.
- Antibiotics. Your doctor may prescribe an antibiotic if your cyst is infected or if testing reveals that you have a sexually transmitted infection. But if the abscess is drained properly, you may not need antibiotics.
- Marsupialization. If cysts recur or bother you, a marsupialization (mahr-soo-pee-uhl-ih-ZAY-shun) procedure may help. Your doctor places stitches on each side of a drainage incision to create a permanent opening less than 1/4-inch (about 6 millimeters) long. An inserted catheter promotes draining for a few days after the procedure and helps prevent recurrence. Depending on how complex your cyst is, you may need to have the procedure done in a hospital operating room under general anesthesia. If you have an active infection, your doctor will likely drain the abscess first, treat the infection with a course of antibiotics and then perform the marsupialization.
Rarely for persistent cysts that aren't effectively treated by the above procedures, your doctor may recommend surgery to remove the Bartholin's gland. Surgical removal is usually done in a hospital under general anesthesia.
Lifestyle and home remedies
Daily soaking in warm water, several times a day, may be adequate to resolve an infected Bartholin's cyst or abscess.
After surgical procedures to treat an infected cyst or abscess, soaking in warm water is particularly important. Sitz baths help to keep the area clean, ease discomfort and promote effective drainage of the cyst. Pain relievers also may be helpful. If you have a catheter in place, after your doctor's approval, you may resume your normal activities, including sex, depending on your level of comfort.
There's no way to prevent a Bartholin's cyst. However, practicing safe sex — in particular, using a condom — and maintaining good hygiene habits may help to prevent infection of a cyst and the formation of an abscess.
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- Pundir J, et al. A review of the management of diseases of the Bartholin's gland. Journal of Obstetrics and Gynaecology. 2008;28:161.
- McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=8880. Accessed March 6, 2012.