A Family Doctor's Tale - BARTHOLIN CYST

DOC I HAVE  A BARTHOLIN CYST

Bartholin cyst is an acute cystic inflammation of the Bartholin gland at the vulva region in females.

Bartholin Gland lies behind the bulb of the vestibule which is the erectile tissue of the female.

When stimulated the bartholin gland which is covered by the erectile tissue(the bulb of the vestibule) will produce a mucoid discharge through a 2 cm duct opening in the vaginal orifice lateral to the hymen.

This mucoid discharge act as a lubricant during the sexual act.

Bartholin cyst occurs when the duct is blocked and forms a painless cyst occurring in the lower half of the vulval wall.

Normally only 1 bartholin gland is affected, rarely two at the same time.

If infection is present an acute abscess results.

Bartholin cyst and abscess can be usually caused by the following:

1.when the duct of the Bartholin gland is blocked by dirt or dead cell or injury.

The fluid which is produced by the gland then cause the gland to swell and forms a painless cyst occurring in the lower half of the vulval wall.

2.A Bartholin abscess occurs when a cyst becomes infected by a number of bacteria.

These bacterial organisms may be:

a.sexually transmitted diseases such as  gonorrhea and chlamydia

b.Escherichia coli and other bacteria normally found in the intestinal tract

Many of these abscesses may be infected by more than one micro-organism.

Symptoms of Bartholin cyst or abscess are:
1.swelling of the labia on one side, near the entrance to the vagina.

2.significant pain may indicate an abscess has formed.
Large cysts can be painful because their size may press against the vulva wall and the nerves.

3.Bartholin's abscess forms a swollen area with extremely tender and reddened skin

4.Walking and sitting may be very painful because of the swollen tender abscess may rub against the opposite vulva wall.

5.Vaginal discharge  is present  especially if the infection is caused by a sexually transmitted organism.

Diagnosis of Bartholin's cyst or abscess is usually made by:

1.physical examination :

a. presence of a lump at the lower part of the vulva wall
The vulva may  show inflammation and excoriation of lining

b.A painful swollen and red lump suggests that an abscess has formed.

2..Vulva and vaginal swab to culture for bacteria and sexually transmitted organisms and the antibiotic most appropriate for it.

3. biopsy of the suspicious vulva swelling to exclude other causes of vulva problem such as tumor

Treatment of Bartholin cyst or abscess involves the following:

1.Small Bartholin's cyst

sitz baths

2.Recurrent cysts or painful abscesss

antibiotics and sitz baths
Approprate Antibiotics is given  for infections especially after the results of the bacterial culture

3.Bartholin's abscesses and cysts that are large and painful

a.Incision and drainage of the abscess which is pus enclosed within an enclosed space.

Since antibiotics cannot adequately enter the enclosed space, incision of the enclosed bag of pus under local anesthetic followed by drainage of a Bartholin's abscess must be done .

After the infected material is drained, the abscess cavity is packed
with gauze keeping the cavity open and promotes further drainage.

Antibiotics and painkillers can be given to relieve the pain after the anesthetic wears off.


The gauze packing is removed after 24 hours.

b.Another surgery called marsupialization can be carried out for recurrent Bartholin cyst or abscess.

After cutting into the cyst wall, drainage of the fluid from the cyst is done.

Then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent hole which acts as a drain site.

This operation usually prevents recurrence of the cyst.

Prognosis of Bartholin cyst:

Prognosis is usually good with medical treatment and surgery.
Most patients  have relief after the 24 hours of drainage.

Prevention of Bartholin cyst:
1.Proper hygience after urination, sexual intercourse and bathing

2.Use of lubricants during sexual intercourse

3.Prompt treatment with sitz baths can prevent the formation of an abscess.

4.Safe sex practices with a single partner can decrease the spread of sexually transmitted diseases