Bartholin's cyst

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Bartholin's cyst
Other namesBartholin duct cyst, Bartholin gland cyst, cyst of Bartholin gland, [1] bartholinitis [2]
Barthonlincyst2011.png
Bartholin's cyst of the right side
Specialty Gynecology
Symptoms Swelling of one side of the vaginal opening, pain, sometimes no symptoms [1]
Complications Abscess [3]
Usual onsetChildbearing age [3]
CausesUnknown [4]
Diagnostic method Based on symptoms and examination [4]
Differential diagnosis Sebaceous cyst, hernia, hidradenitis suppurativa, folliculitis, vulvar cancer, hematoma, gonorrhea, syphilis, genital wart [5] [6]
TreatmentPlacement of a Word catheter, incision and drainage, marsupialization, sitz baths [5] [4]
Frequency2% of women [3]

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked. [4] Small cysts may result in minimal or no symptoms. [1] Larger cysts may result in swelling on one side of the vaginal opening, as well as pain during sex or walking. [4] If the cyst becomes infected, an abscess can occur, which is typically red and very painful. [3] If there are no symptoms, no treatment is needed. [3] [4] Bartholin's cysts affect about 2% of women at some point in their life. [3] They most commonly occur during childbearing years. [3]

Contents

When the cyst becomes uncomfortable or painful, drainage is recommended. [3] The preferred method is the insertion of a Word catheter for four weeks, as recurrence following simple incision and drainage is common. [3] [5] A surgical procedure known as marsupialization may be used or, if the problems persist, the entire gland may be removed. [3] Removal is sometimes recommended in those older than 40 to ensure cancer is not present. [3] Antibiotics are not generally needed to treat a Bartholin's cyst. [3]

The cause of a Bartholin's cyst is unknown. [4] An abscess results from a bacterial infection, but it is not usually a sexually transmitted infection (STI). [7] Rarely, gonorrhea may be involved. [4] [6] Diagnosis is typically based on symptoms and examination. [4] In women over the age of 40, a tissue biopsy is often recommended to rule out cancer. [5] [4]

The cyst is named after Caspar Bartholin who accurately described the glands in 1677. [8] The underlying mechanism of the cyst was determined in 1967 by the obstetrician Samuel Buford Word. [9] [8] [10]

Signs and symptoms

Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting, [3] or sexual intercourse (dyspareunia). [11] They are usually between 1 and 4 cm, and are located just medial to the labia minora. Most Bartholin's cysts only affect the left or the right side (unilateral). While small cysts are usually not painful, larger cysts can cause significant pain.[ citation needed ]

Pathophysiology

A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked. [11] Blockage may be caused by an infection or a mucus plug. [11] The secretions from the Bartholin's gland are retained, forming a cyst. [3]

Diagnosis

Other conditions that may present similarly include hidradenoma papilliferum, lipomas, epidermoid cysts and Skene's duct cysts, among others conditions. [3] In women who are more than 40 years, a biopsy may be recommended to rule out cancer. [3]

Treatment

If the Bartholin's cyst is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. Sitz baths may be useful in draining minor cysts. This is a conservative treatment that involves soaking the vaginal area in a few inches of warm water. It is generally recommended to do this for ten minutes at a time, up to four times per day. This treatment can sometimes cause cysts to spontaneously drain without further intervention. [12]

In cases that require intervention, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, to alleviate swelling and discomfort. [13]

Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst. [3] The balloon is then inflated to keep it in place. A sample of purulent discharge can be sent to a lab for culturing and a biopsy may also be done. [12] The catheter stays in place for 2 to 4 weeks so the fluid can drain and allows a normal gland opening to form (after which the catheter is removed). [14] The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place. [15] Catheterization may be performed multiple times if recurrence occurs. [12] At this point, antibiotics will typically be given in addition to the catheter. Some commonly prescribed antibiotics include Doxycycline, Azithromycin, Ciprofloxacin, and Trimethoprim/sulfamethoxazole, among many others. These antibiotics are chosen to ensure coverage of the most common bacterial pathogens such as Staphylococcus (including Methicillin-resistant Staphylococcus aureus), Streptococcus, and Escherichia coli. [16] Catheterization cannot be performed in individuals with a latex allergy as the catheter used is made of latex. [12]

Cysts may also be opened permanently, a procedure called marsupialization. [14] This involves opening the gland through an incision to ensure that the secretion channel remains open. If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Non-prescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort and reduce pain. Warm compresses can also speed up healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed. [12]

Bartholin's cysts can be treated in the same way for pregnant women as non-pregnant women. The only treatment that should be used with caution in pregnant women is Bartholin gland excision (surgical removal of the gland). This is due to the increased risk for bleeding. [12]

Prognosis

While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgical or laser removal of a cyst makes it less likely that a new one will form at the same site. Those with a cyst are more likely than those without a cyst to get one in the future. They can recur every few years or more frequently.

A randomized control trial (the WoMan trial) was performed in the Netherlands and England from 2010 to 2014. Women with bartholin's cysts were randomly assigned to receive treatment via Word catheter or marsupialization to compare rate of recurrence over a 1-year period. This trial found that recurrence rates were quite similar between the two treatments. Recurrence occurred in 12% of women in the catheter group and 10% of women in the marsupialization group. They did find that the frequency of use of analgesics was greater in the marsupialization group than the catheter group. [17]

Epidemiology

Two percent of women will have a Bartholin's gland cyst at some point in their lives. [3] They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years. [18] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter. [18] Hispanic women may be more often affected than white women and black women. [3] The risk of developing a Bartholin's gland cyst increases with the number of childbirths. [3]

Related Research Articles

<span class="mw-page-title-main">Abscess</span> Localized collection of pus that has built up within the tissue of the body

An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.

The excretory system is a passive biological system that removes excess, unnecessary materials from the body fluids of an organism, so as to help maintain internal chemical homeostasis and prevent damage to the body. The dual function of excretory systems is the elimination of the waste products of metabolism and to drain the body of used up and broken down components in a liquid and gaseous state. In humans and other amniotes, most of these substances leave the body as urine and to some degree exhalation, mammals also expel them through sweating.

<span class="mw-page-title-main">Bartholin's gland</span> Mucous glands located near the vaginal opening

The Bartholin's glands are two pea-sized compound alveolar glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina.

<span class="mw-page-title-main">Cyst</span> Closed sac growth on the body

A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.

<span class="mw-page-title-main">Parotid gland</span> Major salivary gland in many animals

The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.

<span class="mw-page-title-main">Seminal vesicles</span> Pair of simple tubular glands

The seminal vesicles are a pair of convoluted tubular accessory glands that lie behind the urinary bladder of male mammals. They secrete fluid that partly composes the semen.

<span class="mw-page-title-main">Pilonidal disease</span> Skin infection between the buttocks

Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Symptoms may include pain, swelling, and redness. There may also be drainage of fluid, but rarely a fever.

<span class="mw-page-title-main">Mastitis</span> Medical condition

Mastitis is inflammation of the breast or udder, usually associated with breastfeeding. Symptoms typically include local pain and redness. There is often an associated fever and general soreness. Onset is typically fairly rapid and usually occurs within the first few months of delivery. Complications can include abscess formation.

<span class="mw-page-title-main">Chalazion</span> Medical condition

A chalazion or meibomian cyst is not a cyst but a granuloma in the eyelid that results from a blocked meibomian gland. It typically occurs in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.

<span class="mw-page-title-main">Sialadenitis</span> Medical condition

Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands. It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.

<span class="mw-page-title-main">Odontogenic keratocyst</span> Medical condition

An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts. Despite its more common appearance in the bone region, it can affect soft tissue.

<span class="mw-page-title-main">Marsupialization</span> Surgical technique for cysts and abscesses

Marsupialization is the surgical technique of cutting a slit into an abscess or cyst and suturing the edges of the slit to form a continuous surface from the exterior surface to the interior surface of the cyst or abscess. Sutured in this fashion, the site remains open and can drain freely. This technique is used to treat a cyst or abscess when a single draining would not be effective and complete removal of the surrounding structure would not be desirable. The technique is often applied to Gartner's duct cysts, pancreatic cysts, pilonidal cysts, and Bartholin's cysts.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

The term nonpuerperal mastitis describes inflammatory lesions of the breast (mastitis) that occur unrelated to pregnancy and breastfeeding.

<span class="mw-page-title-main">Breast mass</span> Localized swellings that feel different from the surrounding tissue

A breast mass, also known as a breast lump, is a localized swelling that feels different from the surrounding tissue. Breast pain, nipple discharge, or skin changes may be present. Concerning findings include masses that are hard, do not move easily, are of an irregular shape, or are firmly attached to surrounding tissue.

<span class="mw-page-title-main">Tubo-ovarian abscess</span> One of the late complications of pelvic inflammatory disease

A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary. These abscesses are found most commonly in reproductive age women and typically result from upper genital tract infection. It is an inflammatory mass involving the fallopian tube, ovary and, occasionally, other adjacent pelvic organs. A TOA can also develop as a complication of a hysterectomy.

<span class="mw-page-title-main">Bartholin gland carcinoma</span> Medical condition

Bartholin gland carcinoma is a type of cancer of the vulva arising in the Bartholin gland. It typically presents with a painless mass at one side of the vaginal opening in a female of middle-age and older, and can appear similar to a Bartholin cyst. The mass may be big or small, may be deep under skin or appear nearer the surface with overlying ulceration. Average age at presentation is 53-years.

A vestibulectomy is a gynecological surgical procedure that can be used to treat vulvar pain, specifically in cases of provoked vestibulodynia. Vestibulodynia is a chronic pain syndrome that is a subtype of localized vulvodynia where chronic pain and irritation is present in the vulval vestibule, which is near the entrance of the vagina. Vestibulectomy may be partial or complete.

<span class="mw-page-title-main">Vaginal cysts</span> Benign growths of the vaginal epithelium

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Some cysts can be distinguished visually but most will need a biopsy to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.

Vulvar tumors are those neoplasms of the vulva. Vulvar and vaginal neoplasms make up a small percentage (3%) of female genital cancers. They can be benign or malignant. Vulvar neoplasms are divided into cystic or solid lesions and other mixed types. Vulvar cancers are those malignant neoplasms that originate from vulvar epithelium, while vulvar sarcomas develop from non-epithelial cells such as bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Epithelial and mesenchymal tissue are the origin of vulvar tumors.

References

  1. 1 2 3 WHO Classification of Tumours Editorial Board, ed. (2020). "10. Tumours of the vulva: Bartholin gland cyst". Female genital tumours: WHO Classification of Tumours. Vol. 4 (5th ed.). Lyon (France): International Agency for Research on Cancer. p. 440. ISBN   978-92-832-4504-9.
  2. ↑ Zink C (2011). Dictionary of Obstetrics and Gynecology. De Gruyter. p. 24. ISBN   978-3-11085-727-6 . Retrieved November 27, 2023.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Omole F, Simmons BJ, Hacker Y (July 2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–140. PMID   12887119.
  4. 1 2 3 4 5 6 7 8 9 10 Kilpatrick CC. "Bartholin Gland Cysts". Merck Manuals Professional Edition. Retrieved 12 September 2018.
  5. 1 2 3 4 Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–25. doi:10.1159/000365683. PMC   4483306 . PMID   26195958.
  6. 1 2 Ferri F (2017). Ferri's clinical advisor 2018 : 5 books in 1. Elsevier Canada. p. 175. ISBN   978-0-323-28049-5.
  7. ↑ Marx JA (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN   978-1-4557-0605-1.
  8. 1 2 Knaus JV, Isaacs JH (2012). Office Gynecology: Advanced Management Concepts. Springer Science & Business Media. p. 266. ISBN   978-1-4612-4340-3.
  9. ↑ Baskett TF (2019). Mr. United Kingdom: Cambridge University Press. pp. 455–457. ISBN   978-1-108-42170-6.
  10. ↑ Williams Gynecology (2 ed.). McGraw Hill Professional. 2012. p. 1063. ISBN   978-0-07-180465-3.
  11. 1 2 3 Eilber KS, Raz S (September 2003). "Benign cystic lesions of the vagina: a literature review". The Journal of Urology. 170 (3): 717–722. doi:10.1097/01.ju.0000062543.99821.a2. PMID   12913681.
  12. 1 2 3 4 5 6 Lee WA, Wittler M (5 July 2023). "Bartholin Gland Cyst". StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  13. ↑ Stockdale CK, Boardman LA (28 June 2022). Anderson R, Ault K (eds.). "Bartholin's cyst". BestPractice. BMJ Publishing Group.
  14. 1 2 Haider Z, Condous G, Kirk E, Mukri F, Bourne T (April 2007). "The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study". The Australian & New Zealand Journal of Obstetrics & Gynaecology. 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID   17355304. S2CID   36752877.
  15. ↑ Reif P, Elsayed H, Ulrich D, Bjelic-Radisic V, Häusler M, Greimel E, et al. (July 2015). "Quality of life and sexual activity during treatment of Bartholin's cyst or abscess with a Word catheter". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 190: 76–80. doi:10.1016/j.ejogrb.2015.03.008. PMID   25800788.
  16. ↑ Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–25. doi:10.1159/000365683. PMC   4483306 . PMID   26195958.
  17. ↑ Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren P, et al. (January 2017). "Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial". BJOG. 124 (2): 243–249. doi:10.1111/1471-0528.14281. PMID   27640367.
  18. 1 2 Yuk JS, Kim YJ, Hur JY, Shin JH (July 2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International Journal of Gynaecology and Obstetrics. 122 (1): 62–64. doi:10.1016/j.ijgo.2013.02.014. PMID   23618035. S2CID   23981470.
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