Bartholin's Cyst

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

A Bartholin's cyst can stay small and painless and may not cause any symptoms. However, the cyst can become infected, which can cause a painful collection of pus (an abscess) in the Bartholin's gland.

Symptoms

Most Bartholin's cysts do not cause any symptoms. However, you may feel a soft, painless lump in your labia (the two pairs of lips that surround the entrance to your vagina).

You may not know that you have a cyst until it is found during a routine cervical screening test or an examination carried out for another reason.

If the cyst grows very large, it can become uncomfortable and noticeable. You may feel pain in your vulva (external sexual organs) when you walk, sit down or have sex.

Sometimes, the cyst can affect the outer pair of lips around the opening of the vagina (labia majora). One side may look swollen or bigger than usual.

If the cyst or Bartholin's gland becomes infected, an abscess may develop. This is a painful collection of pus that often gets bigger over a few hours or days. 

Signs of an abscess include the affected area becoming red, swollen, tender and hot. An abscess can also cause a high temperature of 38°C (100.4°F) or above.

What causes Bartholin's cysts?

The Bartholin's glands are a pair of pea-sized glands. They are found just behind and either side of the lips that surround the entrance to the vagina. The glands are not usually noticeable because they are 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 not known exactly why the ducts become blocked, but some cases have been linked to bacterial infections. Bacteria are known to sometimes infect existing cysts, causing an abscess to develop.

Bartholin's cysts occur when the tube (duct) from the Bartholin's gland to the vagina becomes blocked and a small fluid-filled sac develops.

It's not known exactly what causes this blockage, but some cases have been linked to bacterial infections.

Bacteria can also infect an existing cyst, causing a collection of pus called an abscess to develop.

Examples of bacteria that have been linked to Bartholin's cysts and abscesses include:

• Gonococcus – usually responsible for gonorrhoea (a sexually transmitted infection or STI)
• Chlamydia trachomatis – usually responsible for chlamydia (another STI)
• Escherichia coli (E. coli) – often responsible for food poisoning
• Streptococcus pneumoniae – responsible for pneumococcal infections, such as infections of the inner ear or sinuses
• Haemophilus influenzae – responsible for a number of infections, including epiglottitis, an infection of the epiglottis (the flap of tissue at the back of your throat)

As some of these bacteria are also responsible for sexually transmitted infections (STIs), such as gonorrhoea and chlamydia, you can help protect yourself against them by practicing safe sex.

When to see your GP

You should always see your GP if you develop a lump in the area around your vagina. They will usually be able to diagnose a Bartholin's cyst from its appearance during a physical examination.

If your GP thinks 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.

In some cases your GP may also advise having a biopsy of the cyst. This involves removing a small sample of tissue so it can be examined under a microscope to check that the cyst is not a sign of a rare type of vulval cancer.

How Bartholin's cysts are treated

If you do not have any noticeable symptoms, it's unlikely you will need 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.

Several treatments are available to treat any pain or infection and drain the cyst if necessary. Most of these treatments involve a minor surgical procedure.

However, Bartholin's cysts are estimated to recur after treatment in about one in every five women.

If a Bartholin's cyst is small and does not cause any symptoms, it's often better to leave it alone. However, you should still see your GP if you notice a lump.

If the cyst is painful, your GP may recommend:

• soaking the cyst for 10 to 15 minutes in a few inches of warm water (it's easier in the bath) – it's best to do this several times a day for three or four days if possible
• holding a warm compress (a flannel or cotton wool warmed with hot water) against the area
• using painkillers such as paracetamol or ibuprofen

Always read the manufacturer's instructions when using over-the-counter medication.

Treating an abscess

If the cyst becomes infected and an abscess (a painful collection of pus) develops, you may be prescribed antibiotics to clear the infection.

Once the infection has been treated, your GP may still recommend having the cyst drained, particularly if the abscess is large.

Draining cysts and abscesses

There are a number of techniques that can be used to drain a Bartholin's cyst or abscess and reduce the chances of the problem recurring. The main procedures used are described below.

Balloon catheter insertion

Balloon catheter insertion, sometimes known as catheter placement or fistulisation, is a procedure used to drain the fluid from the abscess or cyst and create a permanent passage to drain away any fluid that builds up in the future.

This is performed as an outpatient procedure, which means you won't need to stay in hospital overnight. It is usually carried out under local anaesthetic (where you remain conscious, but the area is numbed so you cannot feel anything), but can be done under general anaesthetic (where you are unconscious and cannot feel anything).

During the procedure, a cut is made in the abscess or cyst and the fluid is drained. A specially designed balloon catheter is inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

The balloon is then filled with a small amount of salt water. This increases the size of the balloon so that it fills the cyst or abscess. If you experience any pain, some of the solution can be removed to reduce the pressure slightly. Stitches may be used to partially close the incision and hold the balloon catheter in place.

The catheter will stay in place while new cells grow around it (epithelialisation). This means the surface of the wound heals, but a drainage passage is left in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon is drained and the catheter removed during another appointment.

A few small studies have reported that after balloon catheter insertion, more than 80% of women healed well and their cysts or abscesses did not recur.

Possible complications of balloon catheter insertion include:

• pain while the catheter is in place
• pain or discomfort during sex
• swelling of the labia (the lips around the opening of the vagina)
• infection
• bleeding
• scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used. In marsupialisation, the cyst is first opened with an incision and the fluid is drained out.

The edges of the skin are then stitched in a way that prevents further fluid build-up by allowing it to drain out. This creates a small pouch, similar to a kangaroo's pouch, hence the name marsupialisation.

When the procedure is complete, the treated area may be loosely packed with special gauze to soak up fluid from the wound and stop any bleeding. This will usually be removed before you go home.

Marsupialisation usually takes about 10 to 15 minutes and is normally performed as a day case procedure, so you will not have to stay in hospital overnight. It is most often carried out under general anaesthetic, but it can be done using local anaesthetic instead.

Although complications after marsupialisation are rare, they can include:

• infection
• the abscess recurring
• bleeding
• pain – you may be given painkillers to ease any pain in the first 24 hours after the procedure

You will normally be advised to take things easy for a few days after marsupialisation. You should avoid having sex until the wound has completely healed, which usually takes about two weeks.

Removing the Bartholin's gland

Surgery to remove the affected Bartholin's gland may be recommended in some cases where other treatments haven't been effective and you have repeated Bartholin's cysts or abscesses.

This operation is usually performed under general anaesthetic and takes about an hour to complete. You may need to stay in hospital for two or three days afterwards.

Risks of this type of surgery include bleeding, bruising and infection of the wound. If the wound does become infected, this can usually be treated with antibiotics prescribed by your GP.

Alternative procedures

These procedures are alternative ways of treating a Bartholin's cyst, but are less commonly used or are not widely available.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used in medicine to cauterise (burn) blood vessels to stop bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.

An incision is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).

The silver nitrate causes the cyst cavity to form into a small, solid lump. After two or three days, the piece of silver nitrate and the cyst cavity are removed, or they may fall off on their own.

It is possible for the silver nitrate to burn some of the skin of your vulva when it is first used. One small study reported that this occurs in about one in every five women.

Carbon dioxide laser

A carbon dioxide laser can be used to create an opening in the skin of your vulva so that the cyst can be drained.

The cyst can then be removed, destroyed using the laser, or left in place with a small hole in it to allow fluid to drain from it in the future.

Needle aspiration

During needle aspiration, a needle and syringe are used to drain the cyst.

Sometimes this is combined with a procedure called alcohol sclerotherapy, where the cavity is then filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and then drained out.

Advice after surgery

To help your wound heal and reduce the risk of infection after surgery, you may be advised to:

• avoid having sex and using tampons for up to four weeks
• avoid the use of perfumed bath additives for up to four weeks
• if you had general anaesthetic, you should not drive or perform tasks that need careful attention for 24 to 48 hours

Who is affected?

It's estimated that around 1 in every 50 women will develop a Bartholin's cyst or abscess at some point. The condition usually affects sexually active women aged 20 to 30.

The Bartholin's glands do not start functioning until puberty, so Bartholin's cysts do not usually affect children. The cysts are also uncommon after the menopause as this usually causes the Bartholin's glands to shrink.

Preventing Bartholin's cysts

As it is not clear exactly why Bartholin's cysts develop, it isn't usually possible to prevent them.

However, practicing safe sex can help reduce your chances of picking up a sexually transmitted infection (STI) such as gonorrhoea or chlamydia, which can cause an abscess to develop.

The best way to reduce your chances of developing these infections is by using a condom every time you have vaginal sex.