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 cysts is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. 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. [12]

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. The catheter stays in place for 2 to 4 weeks, draining the fluid and causing a normal gland opening to form, after which the catheter is removed. [13] The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place. [14]

Cysts may also be opened permanently, a procedure called marsupialization, [15] which 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. Nonprescription 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.[ citation needed ]

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. Many women who have marsupialization done find that the recurrences may slow, but do not actually stop.[ citation needed ]

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. [16] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter. [16] 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">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.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<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">Ovarian cyst</span> Fluid-filled sac in the ovary

An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. This may result in vomiting or feeling faint, and even cause head aches.

<span class="mw-page-title-main">Seminal vesicles</span> Pair of simple tubular glands posteroinferior to the urinary bladder of male mammals

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">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">Female reproductive system</span> Reproductive system of human females

The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The human female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo, which develops into the fetus. The uterus also produces secretions, which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.

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

Spermatocele is a fluid-filled cyst that develops in the epididymis. The fluid is usually a clear or milky white color and may contain sperm. Spermatoceles are typically filled with spermatozoa and they can vary in size from several millimeters to many centimeters. Small spermatoceles are relatively common, occurring in an estimated 30 percent of males. They are generally not painful. However, some people may experience discomfort such as a dull pain in the scrotum from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility.

<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">Pelvic examination</span> Physical medical examination

A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used to assess a woman's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the vulva 2) the internal exam with palpation to examine the uterus, ovaries, and structures adjacent to the uterus (adnexae) and 3) the internal exam using a speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.

<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.

<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.

A urethral diverticulum is a condition where the urethra or the periurethral glands push into the connective tissue layers (fascia) that surround it.

Pediatric gynaecology or pediatric gynecology is the medical practice dealing with the health of the vagina, vulva, uterus, and ovaries of infants, children, and adolescents. Its counterpart is pediatric andrology, which deals with medical issues specific to the penis and testes.

<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, Christoph (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, Folashade; Simmons, Barbara J.; Hacker Yolanda (2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–40. PMID   12887119.
  4. 1 2 3 4 5 6 7 8 9 10 "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): 22–5. doi:10.1159/000365683. PMC   4483306 . PMID   26195958.
  6. 1 2 Ferri, Fred (2017). Ferri's clinical advisor 2018 : 5 books in 1. Elsevier Canada. p. 175. ISBN   978-0323280495.
  7. ↑ Marx, John A. Marx (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN   978-1455706051.
  8. 1 2 Knaus, John V.; Isaacs, John H. (2012). Office Gynecology: Advanced Management Concepts. Springer Science & Business Media. p. 266. ISBN   9781461243403.
  9. ↑ Baskett, Thomas F (2019). Mr. United Kingdom: Cambridge University Press. pp. 455–457. ISBN   978-1108421706.
  10. ↑ Williams Gynecology (2 ed.). McGraw Hill Professional. 2012. p. 1063. ISBN   9780071804653.
  11. 1 2 3 Eilber, Karyn Schlunt; Raz, Shlomo (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. ↑ Bartholin's cyst from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013
  13. ↑ Bourne, Tom (2007). "Mr". Australian and New Zealand Journal of Obstetrics & Gynaecology. 47: 137–140 – via Academia.edu.
  14. ↑ Reif, P; Elsayed, H (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.
  15. ↑ 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". Aust N Z J Obstet Gynaecol. 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID   17355304. S2CID   36752877.
  16. 1 2 Yuk, Jin-Sung; Kim, Yong-Jin; Hur, Jun-Young; Shin, Jung-Ho (2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International Journal of Gynecology & Obstetrics. 122 (1): 62–4. doi:10.1016/j.ijgo.2013.02.014. PMID   23618035. S2CID   23981470.
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