Bartholin's cyst
Introduction
A Bartholin's cyst, also called a Bartholin's duct cyst, is a small growth just inside the opening of a woman’s vagina. Cysts are small fluid-filled sacs that are usually harmless.
Bartholin’s glands
The Bartholin’s glands are a pair of pea-sized glands that are found just behind and either side of the labia minora (the inner pair of lips surrounding 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 sexual intercourse. The fluid travels down tiny ducts (tubes) that are about 2cm (0.8 inches) long into the vagina. If the ducts become blocked, they will fill with fluid and expand. This then becomes a cyst.
How common is a Bartholin’s cyst?
According to estimates, around 2% of women will experience a Bartholin’s cyst at some point. The condition usually affects sexually active women between the ages of 20 and 30.
The Bartholin’s glands do not start functioning until puberty, so Bartholin’s cysts do not usually affect children.
During the menopause, the Bartholin’s glands usually shrink. Therefore, any swellings in the vulva (the external sexual organs) of women who have started the menopause are unlikely to be Bartholin’s cysts.
Outlook
A Bartholin's cyst can remain small and painless and may not cause any symptoms. However, it is possible for the cyst to become infected, which can cause an abscess (a painful collection of pus) in the Bartholin’s gland.
If the cyst becomes large or painful, a number of treatments are available to drain and remove the cyst. Most treatments involve a minor surgical procedure under local anaesthetic (painkilling medication), which takes around 20 minutes to complete.
Following surgery to drain and remove a cyst, it will take around two weeks for you to fully recover. Depending on which procedure is used, the cyst or abscess can reoccur in up to 38% of people.
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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 by a healthcare professional during a routine cervical screening test (smear test) or another gynaecological examination. A gynaecologist is a specialist in treating conditions of the female reproductive system.
If the cyst grows very large, it can become uncomfortable and noticeable. You may experience pain in your vulva (external sexual organs) at certain times such as:
- during sexual intercourse,
- when walking, or
- when sitting down.
Sometimes, the cyst can affect the labia majora (the outer pair of lips around the opening of the vagina). One side may look swollen or bigger than usual.
Abscess
An abscess is a painful collection of pus. If the cyst becomes infected, it can cause an abscess. This will be inflamed (swollen) and tender to touch. It can cause a high temperature (fever) of 38°C (100.4°F) or above.
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Causes
A Bartholin’s cyst is caused by an obstruction that blocks the duct (tube) leading from the Bartholin’s gland into the vagina. This leads to a build-up of fluid, which can turn into a cyst.
Several different types of bacteria can cause an infection that blocks the duct. Some types of bacteria can be passed on through sexual contact while others are found in the environment.
Bacteria that may cause a Bartholin’s cyst include:
Visit your GP or a sexual health clinic (GUM clinic) as soon as possible if you have any other symptoms, such as vaginal discharge, itching or pain. You may have a sexually transmitted infection (STI).
If you have an STI, the sooner you receive treatment, the better. Do not have sex until you know the results of your STI tests and you have completed any necessary treatment.
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Diagnosis
Diagnosis of a Bartholin’s cyst usually requires a physical examination by your GP. If you have other symptoms, such as vaginal discharge, your GP may also advise that you have further tests to diagnose any possible sexually transmitted infections (STIs).
Your GP may take a sample of your urine or blood, or may take a swab from your genital area. A swab looks a bit like a cotton bud, but it is smaller, soft and rounded. It is used to collect a sample of cells that can then be tested for any infections.
Alternatively, your GP may refer you to a sexual health clinic (GUM clinic) and these tests will be carried out there. All sexual health services are available free of charge on the NHS. They are available to everyone, regardless of age.
Cyst biopsy
If you have started the menopause, you may be advised to have a biopsy of the cyst. A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope.
A biopsy may be recommended because a growth in your vulva (your external sexual organs) can be a symptom of vulval cancer. This type of cancer is relatively rare, with just over 1,000 cases diagnosed in the UK each year (see Complications).
If you have started the menopause and you notice a swelling in your vagina, see your GP.
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Treatment
No treatment is needed if the Bartholin’s cyst is small and is not causing any symptoms. However, women who have started the menopause are always advised to have a biopsy taken (see Diagnosis). If the cyst is causing some pain, your GP may advise:
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having warm baths,
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using a warm compress (cloths or cotton wool warmed with hot water) held against the area, or
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using pain relief, such as paracetemol or ibuprofen. Always read the manufacturer’s instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given aspirin.
If the cyst becomes an abscess (a painful collection of pus), you may be prescribed antibiotics to clear the infection.
Making an incision (cut) in the cyst and draining the fluid out is not recommended because the cyst will often return. There are now a number of surgical options for treating large, painful cysts and abscesses.
Balloon catheter insertion
Balloon catheter insertion is also sometimes known as word catheter placement or fistulisation.
This procedure is used to drain the fluid from the abscess or cyst and to create a fistula (passage) to drain away any future fluid that builds up. The surface of the fistula is epithelialised (new cells grow over it to heal it), but the passage remains open.
Balloon catheter insertion is carried out on an outpatient basis, which means that you will not need to stay in hospital overnight. It can be carried out under either:
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local anaesthetic, where the area is numbed so that you cannot feel anything during the procedure but you remain conscious throughout, or
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general anaesthetic, where you are unconscious and unable to feel anything.
During balloon catheter insertion, an incision (cut) is made into the abscess or cyst and the fluid is drained. A specially designed balloon catheter (a thin, plastic tube with a small, inflatable balloon on one end) is inserted into the empty abscess or cyst through the incision.
The balloon is then filled with a small amount of saline solution (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 from the balloon to reduce the pressure slightly.
A suture (stitch) may be used to partially close the incision and the balloon catheter is held in place in the cyst.
The catheter will stay in the incision while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon will be drained and the balloon catheter removed.
A few small studies have reported that, after balloon catheter insertion, 83-97% of women healed well and did not have any reoccurrence of cysts or abscesses.
Possible complications of balloon catheter insertion include:
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pain from having the catheter left in,
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pain during sexual intercourse,
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swelling of the labia (the fleshy lips around the opening of the vagina),
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infection,
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the abscess reoccurring,
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bleeding, and
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scarring.
Alternative procedures
A number of other possible surgical procedures can be used to treat Bartholin’s cyst. These procedures are all performed under local anaesthetic, on an outpatient basis, and take around 15-20 minutes. Healing usually takes around two weeks and the possible complications are the same as those listed above.
Marsupialisation
In marsupialisation, the cyst is opened with an incision (cut) and the fluid is drained out. The edges of the skin are then stitched back together in a way that allows any further fluid build-up to continue to drain out.
Silver nitrate gland ablation
Silver nitrate is a mixture of chemicals that is sometimes used in medicine, for example to cauterise (burn) the ends of blood vessels to stop them bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.
During the procedure, an incision (cut) 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 to 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 on the first day that it is inserted. One small study reported that burning of the mucous membrane (the moist lining) of the vulva occurs in 20% of women.
Carbon dioxide laser
Another procedure involves using a laser to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then either be:
- removed,
- destroyed using the laser, or
- left attached, but with a hole in it.
Needle aspiration
During needle aspiration, a needle is used to drain the cyst.
Alcohol sclerotherapy
During alcohol sclerotherapy, a needle is used to drain the cyst and the cavity is filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and is then drained out.
Gland excision
Gland excision is the removal of Bartholin’s gland. The procedure can take up to an hour to complete.
Reoccurrence
The rate of reoccurrence of a cyst or abscess after one of these procedures is, on average, around 20%. One study of needle aspiration found the reoccurrence rate to be 38% and one study of marsupialisation found no reoccurrences.
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Complications
Vulval cancer
Bartholin’s cyst could be a symptom of vulval cancer. This is a type of cancer that affects the vulva (a woman’s external sexual organs).
Occasionally, vulval cancer can affect the Bartholin’s glands (the two glands either side of the vagina) and a growth or cyst may appear.
Vulval cancer is a relatively rare form of cancer, with about 1,000 cases diagnosed in the UK each year. There are several different types of vulval cancer and, depending on the stage of the condition when it is diagnosed, the outlook can be good.
Visit your GP immediately if you notice any changes to your vagina, such as pain or itching.
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Prevention
A number of bacteria can cause a Bartholin’s cyst (see Causes) and you may not be able to avoid being exposed to all of them.
Some of these bacteria are also responsible for sexually transmitted infections (STIs), such as gonorrhoea and chlamydia. You can protect yourself against these infections by practising safer sex.
Safer sex
If you are sexually active, having safe sex gives you and your partner the best protection against STIs.
Following the advice below will enable you to have a safer sex life.
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Keep the number of sexual partners that you have to a minimum.
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Use a barrier method of contraception, such as
condoms, every time you have vaginal or anal sex.
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If you have oral sex, cover the penis with a condom or the female genitals with a latex or a polyurethane (plastic) square (dam). Find out
how to use a condom.
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Do not share sex toys. If you do share them, wash them thoroughly after use or cover them with a new condom before anyone else uses them.
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You and your sexual partner(s) should also have regular check-ups for sexually transmitted infections (STIs). This can be done at your GP surgery or a
sexual health clinic (GUM clinic).
These measures will help you avoid getting an STI. If you have an STI, they will prevent you from passing it on to your partner.
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