A Bartholin’s cyst is a fluid-filled sac within one of the Bartholin’s glands of the vagina. The exact incidence of Bartholin’s cysts and abscesses is uncertain, but abscesses account for 2% of all gynaecological visits a year. Asymptomatic cysts may occur in up to 3% of women, although they often do not present to healthcare services.
Aetiology and Pathophysiology
The Bartholin’s glands (greater vestibular glands) are located deep to the posterior aspect of the labia majora. Their openings are located either side of the vaginal orifice, within the vestibule of the vagina (approximately 4 o’clock and 8 o’clock positions), just below the hymenal ring. They secrete mucus to lubricate the vagina
A build-up of mucus secretions can cause the duct of the gland to become blocked, from which a cyst can develop. The cyst itself can become infected, and if untreated, develop into an abscess.
The infective organisms are usually aerobic, with Escherichia coli, MRSA and STI’s the most common.
Risk Factors
Bartholin’s cysts characteristically occur in nulliparous women of child-bearing age. Other risk factors include:
Clinical Features
Small Bartholin’s cysts are often asymptomatic. If they become large, they can cause vulvar pain (particularly when walking and sitting), and superficial dyspareunia (pain during sexual intercourse). The cyst can undergo spontaneous rupture – after which the patient typically experiences a sudden relief of pain.
Bartholin’s abscesses typically present with acute onset of pain, and/or difficulty passing urine. On examination, a unilateral labial mass will be observed. This typically arises from the posterior aspect of the labia majora, although a large cyst or abscess can expand anteriorly.
Investigations
The diagnosis of a Bartholin’s cyst or abscess is often a clinical one, and further investigations are not routinely required. However – if the woman is over 40 years of age, a biopsy of the cyst should be considered (especially if there are solid components to the swelling) – this is to exclude vulval carcinoma.
If there are any indications of a sexually transmitted infection, endocervical and high vaginal swabs should be taken.
Management
If the cyst is small and asymptomatic, no treatment is required. Warm baths can be recommended to the patient, as they may stimulate spontaneous rupture. Treatment is usually by removal / excision or marsupialisation.