Bartholin’s Cyst

The Bartholin’s glands are a pair glands located either side of the posterior part of the vaginal introitus (the vaginal opening). They are usually pea-sized and not palpable. They produce mucus to help with vaginal lubrication. 

When the ducts become blocked, the Bartholin’s glands can swell and become tender, causing a Bartholin’s cyst. The swelling is typically unilateral and forms a fluid-filled cyst between 1 – 4 cm.

Cysts can become infected, forming a Bartholin’s abscess. A Bartholin’s abscess will be hot, tender, red and potentially draining pus. 

A diagnosis of a Bartholin’s cyst or abscess is made clinically with a history and examination. 

 

Management

Bartholin’s cysts will usually resolve with simple treatment such as good hygiene, analgesia and warm compresses. Incision is generally avoided, as the cyst will often reoccur. A biopsy may be required if vulval malignancy needs to be excluded (particularly in women over 40 years).

Bartholin’s abscess will require antibiotics. A swab of pus or fluid from the abscess can be taken to culture the infective organism and check the antibiotic sensitivitiesE. coli is the most common cause. Send specific swabs for chlamydia and gonorrhoea

Surgical interventions may be required to treat a Bartholin’s abscess. There are two options for surgical management:

  • Word catheter (Bartholin’s gland balloon) – requires local anaesthetic 
  • Marsupialisation – requires general anaesthetic

Word catheter is a small rubber tube with a balloon on the end. The procedure may be performed by an appropriately experienced person in a treatment room, rather than a theatre. Local anaesthetic is used to numb the area. An incision is made, and any pus is drained from the abscess. The Word catheter is inserted into the abscess space, and inflated up to 3 ml with saline. The balloon fills the space and keeps the catheter in place. Fluid can drain around the catheter, preventing a cyst or abscess reoccurring. The tissue heals around the catheter, leaving a permanent hole. The catheter can be deflated and carefully removed at a later date, once epithelisation of the hole has occurred.

Marsupialisation involves a general anaesthetic in a surgical theatre. An incision is made, and the abscess is drained. The sides of the abscess are sutured open. Suturing the abscess open allows continuous drainage of the area and prevents recurrence of the cyst or abscess. 

 

Last updated June 2020
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