Bartholin’s cyst – NHS

A Bartholin’s cyst, also called a Bartholin’s duct cyst, is a small fluid-filled sac just inside the opening of the vagina.

Symptoms of a Bartholin’s cyst

You may feel a soft, painless lump. This does not usually cause any problems.

But if the cyst grows very large, it can become noticeable and uncomfortable. You may feel pain in the skin surrounding the vagina (vulva) when you walk, sit down or have sex.

The cyst can sometimes affect the outer pair of lips surrounding the vagina (labia majora). One side may look swollen or bigger than usual.

If the cyst becomes infected, it can cause a painful collection of pus (abscess) to develop in one of the Bartholin’s glands.

Signs of an abscess include the affected area becoming red, swollen, tender and hot. It can also cause a high temperature.

When to see a GP

Small Bartholin’s cysts are sometimes only found during a routine cervical screening test or an examination carried out for another reason.

Always see a GP if you develop a lump in the area around your vagina so they can confirm a diagnosis and rule out more serious conditions.

If they think the cyst or one of your Bartholin’s glands may be infected, they may use a swab to remove a sample of discharge for analysis to identify the bacteria responsible.

Sometimes, a GP may recommend you have a biopsy. A small sample of cyst tissue will be removed and examined under a microscope to check for signs of a rare type of vulval cancer called Bartholin’s gland cancer.

What causes Bartholin’s cysts?

The Bartholin’s glands are a pair of pea-sized glands found just behind and either side of the lips that surround the entrance to the vagina.

The glands are not usually noticeable because they’re rarely larger than 1cm (0.4 inches) across.

The Bartholin’s glands secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes called ducts into the vagina.

If the ducts become blocked, they can fill with fluid and expand to form a cyst.

It’s often not known why the ducts become blocked, but sometimes it’s linked to sexually transmitted bacterial infections (STIs), such as gonorrhoea or chlamydia, or other bacterial infections, such as Escherichia coli (E. coli).

How Bartholin’s cysts are treated

If you do not have any noticeable symptoms, it’s unlikely you’ll need treatment.

If the cyst is painful, a GP may recommend some simple self-care measures, such as soaking the cyst in warm water several times a day for 3 or 4 days and taking painkillers you can buy from a pharmacy or supermarket.

If these do not work, several treatments are available to treat the pain and any infection. If necessary, the cyst can be drained. Most of these treatments involve a minor surgical procedure.

A Bartholin’s cyst can sometimes return after treatment.

Who’s affected

A Bartholin’s cyst usually affects sexually active women aged 20 to 30.

Bartholin’s cysts do not usually affect children because the Bartholin’s glands do not start functioning until puberty. 

The cysts are also uncommon after the menopause as this usually causes the Bartholin’s glands to shrink.

Preventing Bartholin’s cysts

It’s not clear exactly why Bartholin’s cysts develop, so it’s not usually possible to prevent them.

But as some are thought to be linked to STIs, practising safe sex (using a condom every time you have sex) can help reduce your chances of developing Bartholin’s cysts .

Get more advice about STIs

Page last reviewed: 26 October 2021
Next review due: 26 October 2024

Bartholin cyst or abscess Information | Mount Sinai

Abscess – Bartholin; Infected Bartholin gland

Bartholin abscess is the buildup of pus that forms a lump (swelling) in one of the Bartholin glands. These glands are found on each side of the vaginal opening.

External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

Bartholin glands are found on each side of the vaginal opening. A Bartholin cyst is a buildup of fluid that occurs if the opening of the gland is blocked. A Bartholin abscess may occur if the cyst fluid becomes infected. The Bartholin cyst or abscess appears as a lump or swelling on the side of the vaginal opening.

Causes

A Bartholin abscess forms when a small opening (duct) from the gland gets blocked. Fluid in the gland builds up and may become infected. Fluid may build up over many years before an abscess occurs.

Often the abscess appears quickly over several days. The area will become very hot and swollen. Activity that puts pressure on the vulva, and walking and sitting, may cause severe pain.

Symptoms

Symptoms may include:

• A tender lump on either side of the vaginal opening
• Swelling and redness
• Pain with sitting or walking
• Fever, in people with low immunity
• Pain with sexual intercourse
• Vaginal discharge
• Vaginal pressure

Exams and Tests

The health care provider will do a pelvic exam. The Bartholin gland will be enlarged and tender. In rare cases, a biopsy may be suggested in older women to look for a tumor.

Any vaginal discharge or fluid drainage will be sent to a lab for testing.

Treatment

SELF-CARE STEPS

Soaking in warm water 4 times a day for several days can ease the discomfort. It can also help the abscess open and drain on its own. However, the opening is often very small and closes quickly. Therefore, the abscess often returns.

DRAINAGE OF THE ABSCESS

A small surgical cut can completely drain the abscess. This relieves symptoms and provides the fastest recovery.

• The procedure can be done under local anesthesia in a provider’s office.
• A 1 to 2 cm cut is made at the site of abscess. The cavity is irrigated with normal saline. A catheter (tube) may be inserted and left in place for 4 to 6 weeks. This allows continuous drainage while the area heals. Sutures are not required.
• You should begin soaking in warm water 1 to 2 days afterward. You cannot have sexual intercourse until the catheter is removed.

You may be asked to have antibiotics if there is pus or other signs of infection.

MARSUPIALIZATION

Women can also be treated with a minor surgery called marsupialization.

• The procedure involves creating an elliptical opening along the cyst to help the gland drain. The abscess is removed. The provider places stitches at the edges of the cyst.
• The procedure can sometimes be done in the clinic with medicine to numb the area. In other cases, it may need to be done in the hospital with general anesthesia so that you are asleep and pain-free.
• You should begin soaking in warm water 1 to 2 days afterward. You cannot have sexual intercourse for 4 weeks after surgery.
• You can use oral pain medicines after the procedure. Your provider may prescribe narcotic pain medicines if you need them.

EXCISION

Your provider may recommend that the glands be completely removed if abscesses keep coming back.

• The procedure involves surgical removal of the entire cyst wall.
• Generally performed in the hospital under general anesthesia.
• You cannot have sexual intercourse for 4 weeks after surgery.

Outlook (Prognosis)

The chance of a full recovery is excellent. The abscesses may return in few cases.

It is important to treat any vaginal infection that is diagnosed at the same time as the abscess.

When to Contact a Medical Professional

Call your provider if:

• You notice a painful, swollen lump on the labia near the vagina opening and it does not improve with 2 to 3 days of home treatment.
• Pain is severe and interferes with your normal activity.
• You have one of these cysts and develop a fever higher than 100.4°F (38°C).

Ambrose G, Berlin D. Incision and drainage. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 37.

Dolan MS, Hill C, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Smith RP. Bartholin gland cyst/abscess drainage. In: Smith RP, ed. Netter’s Obstetrics and Gynecology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 251.

Tuggy ML. Bartholin cyst and abscess: word catheter insertion marsupialization. In: Fowler GC, ed. Pfenninger and Fowler’s Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 118.

Last reviewed on: 4/19/2022

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Bartholinitis – causes and types of disease

Causes of bartholinitis

Inflammation in the Bartholin gland is caused by infectious agents that enter it from the vagina or urinary tract. The causative agent of the disease can be gonococcus, Trichomonas or other microorganisms. Cases of spread of infection through the blood are known.

The entry of a pathogen into the gland does not always cause bartholinitis. The onset of the inflammatory process is provoked by various external and internal factors:

• chronic diseases: caries, pyelonephritis, sinusitis and other sources of infection in the body;
• weak immunity against the background of a cold, lack of vitamins, stress, pregnancy;
• damage to the Bartholin gland as a result of surgery, abortion;
• promiscuous and unprotected sexual intercourse, etc.

At the initial stage, inflammation of the mucous membranes occurs. The natural outflow of the secret is blocked – the secretions begin to accumulate in the gland and form a cyst. Gradually education grows. The cyst of the Bartholin’s gland is filled with purulent contents, and an abscess occurs. A woman can feel education on her own. The abscess is located on the labia, looks like a small bump, painful when pressed.

Forms and symptoms of bartholinitis

According to the severity of the course, inflammation is acute and chronic.

Acute bartholinitis begins with canaculitis. Inflammation affects only one gland, so local symptoms are one-sided. Bilateral canaculitis usually occurs when infected with gonorrhea. The patient during this period may not feel acute symptoms. Anxious signs are noticed by the doctor during the examination. Redness appears at the exit site of the gland duct. The channel itself for the discharge of the secret begins to be palpated well. When pressed, a purulent discharge appears from the gland. At the stage of canaculitis, inflammation can be stopped quickly enough. If no action is taken, the swelling will increase and block the duct. Gradually, the inflammation will move to the gland itself.

Acute bartholinitis exists in two forms:

• true abscess. The infectious agent penetrates the body of the gland. Patients complain of severe pain that worsens with movement. Inguinal lymph nodes increase, a large edema is formed. Fever and high body temperature – up to 40 degrees are added to the signs of bartholinitis. Opening an abscess brings only temporary relief. In addition, damage to the cyst with purulent bartholinitis can lead to sepsis, so you can’t squeeze out the bump on your own – it’s life-threatening. At the first signs, it is necessary to enroll in gynecology to receive qualified assistance;
• False abscess (formed during the progression of canaculitis). A woman with bartholinitis complains of an increase in body temperature up to 37.5 degrees, pain in the perineum. One-sided swelling appears on the labia at the location of the abscess. The focus of infection is not in the gland, but next to it. As pus accumulates, the cyst increases in size, becomes painful, and the skin turns red.

Chronic bartholinitis is a consequence of an untreated acute form. Short remissions are replaced by exacerbations. The next cycle, any infection, stress, beriberi, etc. can provoke a relapse. The chronic form is difficult to treat even when the exact cause of inflammation is established.

Subacute bartholinitis is also distinguished, but such a diagnosis is rare. The disease is characterized by the subsidence of acute symptoms and gradually turns into a chronic process.

Bartholinitis during pregnancy

Any inflammation in the female genital organs is a danger to the fetus. That is why pregnant patients should regularly come to see a gynecologist and take tests. Preventing inflammation is much easier than treating it.

During pregnancy, a natural decrease in immunity occurs. The body suppresses defense reactions so as not to reject the fetus, which is 50% genetically alien. Under such conditions, the mother’s body cannot provide a reliable barrier to infection. When it enters the genital tract, the pathogens rise up and reach the uterus. A disease such as bartholinitis threatens intrauterine infection of the fetus through the umbilical cord. Infections cause multiple mutations, interfere with the processes of organogenesis. In critical cases, we are talking about abortion.

Complications can be avoided with early registration in gynecology and timely diagnosis of inflammation. The doctor may already suspect a dangerous situation based on the results of a smear, even before the onset of symptoms. Inflammation is stopped, not allowing it to spread in the genitals. Under medical supervision, women calmly carry the pregnancy to natural childbirth.

Diagnosis of bartholinitis

The doctor begins by taking an anamnesis and examining the patient. Before your appointment, be prepared to answer the following questions:

• the date of the beginning and end of the last menstruation;
• the onset of puberty and intimate life;
• the nature of menstruation;
• number of pregnancies and their outcome;
• the time of onset of the first symptoms and the rate of their increase;
• the nature of the complaints;
• the presence of bad habits, other provoking factors.

After collecting an anamnesis, the patient is examined on a gynecological chair. On the external genitalia, bartholinitis is visible visually. The doctor examines the abscess, takes a smear from the walls of the vagina and a sample of the secretion of the gland. The received materials are sent for laboratory research. Only after receiving the results of the tests, the doctor can confidently diagnose and prescribe treatment for bartholinitis cysts. Analyzes are then taken several more times to monitor the effectiveness of therapy.

Treatment of bartholinitis

Do not try to heal yourself! Compresses, baths, attempts to open and clean the abscess end very badly. Patients often come to the appointment after self-treatment with severe fever, extensive inflammation, which requires urgent hospitalization. Don’t risk your health. Contact your doctor in a timely manner.

In the initial stage, doctors treat bartholinitis without surgery. The patient is selected a scheme of conservative therapy, prescribed antifungal drugs, antibiotics. To normalize the intestinal microflora, you will need products with bifidobacteria and vitamins. Surgical removal of a Bartholin gland cyst is not required. To relieve swelling a little, you can apply a heating pad or any other ice container wrapped in a soft cloth to the inflamed area. For treatment, therapeutic tampons with levomekol, Vishnevsky ointment, saline applications, solutions of chlorhexidine, miramistin are also used.

After removing the exacerbation, sitz baths are prescribed with a weak solution of potassium permanganate (1 sl. L. per 1 liter of water). You can use a decoction of chamomile for the same purpose. Bath time – 20 minutes. After the condition improves, they proceed to physiotherapy.

A woman must strictly follow the doctor’s recommendations – this is the only way to prevent the complications of bartholinitis.

A true abscess requires surgery. Operations on the Bartholin’s gland are carried out by two methods:

• Complete removal – extirpation. The doctor excised diseased tissue, removes the gland along with the focus of inflammation. After the operation, the woman goes through a period of rehabilitation with complete sexual rest;
• Formation of a new gland duct. An incision is made in the tissues to remove the secret. The technique helps to temporarily alleviate the patient’s condition, but the risk of recurrence of bartholinitis is high. The incisions quickly overgrow, a cyst is formed again.

There are more gentle, modern methods of treating bartholinitis in gynecology. An annular catheter is installed in the body of the gland (marsupialization operation). Within 2 months, the catheter performs the functions of a natural duct and promotes secretion. Such an operation is less traumatic, the risk of recurrence is minimal. During the rehabilitation period, a woman undergoes a course of magnetotherapy, UV irradiation.

Expert opinion

Women who regularly come for examinations to the gynecologist can see such a diagnosis in the chart as an asymptomatic course of a Bartholin gland cyst. The doctor does not comment on this situation in any way, does not prescribe pills, the patient begins to worry. But there is no reason to panic. A cyst with asymptomatic treatment does not require any radical measures. Regular monitoring, proper hygiene, balanced nutrition are necessary. The female body, with sufficient support, copes with the stagnation of the secret on its own. Therefore, listen to your doctor and do not self-medicate.

Prevention of bartholinitis

To reduce the risk of inflammation, it is necessary to strengthen the immune system, observe the rules of intimate hygiene, and have sexual relations with one regular partner. It is important to treat gynecological diseases in time and at least once a year undergo a preventive examination by a doctor.

Be careful with your choice of underwear. It should be sufficiently free, elastic, made of natural fabrics. For intimate hygiene, use gels with a neutral pH, without dyes and fragrances. A healthy lifestyle and proper nutrition is the best prevention for most diseases.

The doctors of the Alfa Health Center clinic will help you cope with bartholinitis and restore your women’s health. Call us to make an appointment and find out the price of the consultation.

Sources:

1. Clinical protocol for the diagnosis and treatment of inflammatory diseases of the perineum, vulva, vagina. Electronic version.

2. Bartholinitis. Medical encyclopedia. Electronic version.

Bartholin gland cyst | Center Dikul

Bartholin’s cyst (or vulvar cyst) is a cyst that can form on both sides of the labia, near the entrance to the vagina. The cyst is formed from the Bartholin glands, which produce the mucus needed to lubricate the vagina. The Bartholin glands and labia are part of the female reproductive system.

A Bartholin gland cyst is formed when the outflow of fluid from the opening of the gland is disturbed and mucus accumulates and a tubercle forms. Usually, a cyst develops on only one of the two Bartholin’s glands. Some Bartholin gland cysts are small and do not cause pain. If the cyst becomes infected, then an abscess is formed and pain may appear, and then treatment is required.

Symptoms

In most cases, a Bartholin’s cyst does not cause symptoms and can be detected during hygiene care or after a gynecological examination. Typically, cysts are painless and resolve on their own.

Some women may experience discomfort with movement or during intercourse, while others may experience general swelling of the vulva.

However, the cyst can become infected with bacteria and fester, forming an abscess. When an abscess forms, there may be symptoms such as:

• Presence of red swollen bump
• Greenish-yellow purulent discharge from swelling
• High fever with chills
• Body aches
• General weakness

Bartholin’s cyst in some cases becomes very large and causes discomfort when walking, sitting, having sex. Even if the cyst is not infected, if it is large, it can cause pain.

Causes

A Bartholin gland cyst forms when there is a blockage in the orifice of the Bartholin gland. The Bartholin glands are located to the left and right of the entrance to the vagina, and they produce mucus that lubricates the tissues of the vagina. With blockage, mucus cannot leave the gland and a cyst forms.

Causes of blockage are not always known, but may include:

• Bacterial vaginal infection, such as E. coli.
• Thick consistency of vaginal mucus
• Injuries of the vagina
• STDs such as chlamydia and gonorrhea
• Surgical vulvovaginal procedures

Statistics show that 2% of women develop a Bartholin gland cyst during their lifetime. The cyst most often forms in sexually active women between the ages of 20 and 30. As age increases, the risk of developing a cyst decreases, as there is a gradual decrease in Bartholin’s glands and a decrease in mucus secretion.

When should I see a doctor?

A woman should contact her doctor if she develops a painful lump near the entrance to the vagina that does not go away after two or three days of self-care, such as soaking the area in warm water (sitz bath). If the pain is severe, you should immediately make an appointment with a doctor.

You should also contact your doctor immediately if a woman finds a new tumor near the entrance to the vagina and she is over 40 years old. Although such a tumor is rare, it can be a sign of a more serious problem, such as cancer.

Diagnosis

A doctor diagnoses a Bartholin’s cyst during a gynecological examination. The doctor will also take a medical history and take a mucus sample to check for infections such as gonorrhea and chlamydia.

If the woman is menopausal or postmenopausal, her doctor may recommend a biopsy to rule out vulvar cancer. During a biopsy, a part of the cyst is taken for examination of the tissue in the laboratory under a microscope.

Depending on the woman’s age and the risk of sexually transmitted infections, the doctor may recommend laboratory tests (blood tests for infections such as chlamydia, gonorrhea, syphilis, HIV).

Treatment

If a Bartholin’s cyst does not cause symptoms, then treatment may not be required as it may disappear on its own. However, if a woman notices an increase in the size or change in the shape of the cyst, then she needs to see a doctor.

If the cyst is painful or uncomfortable, your doctor may recommend warm sitz baths several times a day for three to four days. This may improve drainage and rupture of the cyst.

Women are advised not to open the cyst themselves, as this greatly increases the risk of infection.

Medications

Analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be recommended to reduce inflammation and pain.

If an abscess has formed, your doctor may prescribe an oral antibiotic such as cipro (ciprofloxacin), rocefin (ceftriaxone), zithromax (azithromycin), or doxycycline to help clear the infection.

If a woman is diagnosed with chlamydia, either a single dose of an antibiotic or a course of treatment can be prescribed. For gonorrhea, a single intramuscular injection of Rocephin (ceftriaxone) is usually recommended. If chlamydia is not ruled out, oral doxycycline (100 mg twice daily for seven days) is recommended.

Specialized Procedures

If the cyst does not resolve after home treatment or the cyst is infected and large, the doctor may prescribe surgical procedures.

Treatment options include:

• Needle aspiration: This procedure can be performed on an outpatient basis and involves inserting a needle into the cyst to suck out pus. This procedure is rarely used because of the high risk of recurrence.
• Incisional drainage: This procedure involves cutting the cyst and draining the fluid. After that procedure, there are also relapses.
• Insertion of a catheter. This procedure involves inserting a balloon catheter into the cyst after it has been incised and drained.