Bartholin's cysts are soft painless lumps that can occur in the lubricating glands found at the opening of a woman’s vagina. If the cysts become infected they can form a painful abscess. See your GP if you develop a lump in the area around your vagina, so they can confirm a diagnosis and rule out more serious conditions.
Key points
- Bartholin’s glands are a pair of pea-sized glands found either side of the opening to the vagina. They secrete fluid that acts as a lubricant during sex.
- If the opening (ducts) in the glands become blocked, they can fill with fluid and expand to form a soft, painless lump or Bartholin’s cyst.
- This doesn't usually cause any problems, but if it grows or becomes infected it will form an abscess. If this happens, you may feel pain in the area when you walk, sit down or have sex.
- Treatment depends on the size of the cyst, how painful it is and whether it is infected.
- Around 1 in every 50 women will develop a Bartholin’s cyst or abscess. It is most common in sexually active women aged between 20 and 30.
Image: Primary Care Dermatology Society, UK
What are the causes of Bartholin’s cyst and Bartholin's abscess?
It's usually not known why Bartholin’s ducts become blocked, but once a lump (cyst) has developed, the fluid inside can easily become infected. Usually, the infection is from bacteria commonly found in the vagina. However, sometimes bacteria that can cause sexually transmitted infections (such as gonorrhoea or chlamydia) cause the infection.
What are the symptoms of Bartholin’s cyst?
You might feel a lump or fluid-filled mass near your vaginal opening. This is usually painless but it can be tender. If the cyst becomes infected, you may experience:
- a tender, painful lump near your vaginal opening
- discomfort while walking or sitting
- pain during intercourse.
How is Bartholin’s cyst diagnosed?
Always see your GP if you find a lump in your vaginal region so they can confirm a diagnosis and ensure appropriate treatment is received. If your GP thinks the cyst may be infected, they may swab it and send a sample to the lab for analysis to identify the bacteria responsible. In some cases, your GP may recommend you have a biopsy (sample of tissue removed) so it can be checked for signs of a rare cancer, called Bartholin’s gland cancer.
How is Bartholin’s cyst treated?
Depending on the size of the cyst or abscess, and the severity of your symptoms, treatment options range from self-care and medication to drainage or surgical removal of the cyst.
Self-care
If you can feel the cyst, but it is not growing, sore or infected, it’s unlikely you need any treatment. If the cyst is painful, your GP may recommend some simple self-care measures, such as:
- soaking the cyst in warm water several times a day for three or four days using a sitz bath
- taking over-the-counter painkillers.
- if you are prescribed antibiotics, taking the full course.
Medication
If the cyst is infected (developed into an abscess), your doctor may prescribe antibiotics. If the abscess does not respond to antibiotics, you may need to have one of the following procedures.
Word catheter balloon insertion (procedure)
This procedure takes around 15 minutes and is carried out under a local anaesthetic. It involves making a channel from the cyst or abscess through which the gland can drain. A small cut is made in the abscess and a small flexible tube (catheter) with a small balloon at its tip is inserted to create a passage. It is usually offered to women under 40.
Marsupialisation (surgery)
This surgery is done under general anaesthetic and takes about 10–15 minutes. The doctor makes a small cut in the abscess and gland to release the fluid, sewing the edges to the surrounding skin. This keeps the cut open, so it can heal and for the abscess to drain out. This prevents another abscess from forming later. The small cut will completely heal by itself.
Excision (surgery)
This surgery involves the removal of the cyst or abscess under general anaesthetic. It is carried out so that the area can be fully examined when the cyst or abscess is removed. During excision, the entire gland is removed. This procedure is only considered in women over 40 who have had abscesses recur on several occasions. As result of excision, the gland will no longer function which means that your body will produce less lubricant.
This loss of lubrication can make having sex uncomfortable. To improve lubrication, you can use lubricants or vaginal moisturisers. If these are not effective for you, talk to your doctor about whether vaginal oestrogen and hormone replacement therapy (HRT) are suitable for you.
How can I prevent Bartholin’s cyst?
Because it's not clear exactly why Bartholin's cysts develop, it isn't usually possible to prevent them. However, some cysts are thought to be linked to sexually transmitted infections, so practising safe sex (using a condom every time you have sex) might help reduce your chances of developing one.
Learn more
The following links provide further information about Bartholin’s cyst. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Bartholin's cyst and abscess Patient Info, UK, 2017
Bartholin’s cyst NHS, UK, 2015
Sitz bath Healthline, US, 2017
References
- Haider Z, Condous G, Kirk E, Mukri F, Bourne T. 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.
- Treating a Bartholin's cyst or abscess Guys’ and St Thomas’ NHS Foundation Trust, UK, 2017
- Bartholin's cyst Mayo Clinic, US, 2015
- Vaginal dryness NHS Choices, UK, 2016
Reviewed by
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Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland. |