Bartholin's Cyst

Helpful Bacteria (Acidophilus) Picture

• The two Bartholin's glands are located at the entrance to a woman's vagina, one on each side. They are small and cannot be seen or felt when they are normal.
• Their function is to secrete fluid onto the mucosal (inner) surface of the labia-the liplike skin surrounding the vagina.
• Problems with the Bartholin's glands include cysts, which are relatively painless enlargements of the gland, and abscesses, which are infections of the gland.
• Women with Bartholin's abscesses do not usually have a fever.
• Typically only one of the two glands is affected.
• Bartholin's cysts and abscesses often require drainage by a doctor.
• The majority of women feel much better within 24 hours of drainage.

A Bartholin's cyst develops when the duct exiting the Bartholin's gland becomes blocked. The fluid produced by the gland then accumulates, causing the gland to swell and form a cyst. An abscess occurs when a cyst becomes infected.

Bartholin's abscesses can be caused by any of a number of bacteria. These include bacterial organisms that cause sexually transmitted diseases such as chlamydia and gonorrhea as well as bacteria normally found in the intestinal tract, such as Escherichia coli. It is common for these abscesses to involve more than one type of organism.

Picture of Bartholin's Cyst

• A Bartholin's cyst causes swelling of the labia on one side, near the entrance to the vagina. A cyst is usually not very painful, and significant pain suggests that an abscess has developed. However, large cysts may be painful simply by virtue of their size.
• A Bartholin's abscess causes significant pain in addition to the swelling. The swollen area is extremely tender and the skin reddened. Walking and sitting may be quite painful.
• Women with Bartholin's abscesses do not usually have fever. Vaginal discharge may be present, especially if the infection is caused by a sexually transmitted organism.

See a doctor if any genital lump or mass continues to enlarge or does not improve within a few days of home treatment.

• If a lump or mass is painful, this suggests that an abscess has developed. It needs to be drained.
• If other symptoms develop, including vaginal discharge, fever, or vomiting, call the doctor.
• With Bartholin's cysts and abscesses, the primary reason to seek emergency care is acute pain. Women who are experiencing severe pain or who cannot sit or walk comfortably should see a doctor as soon as possible. Although symptoms such as high fever and abdominal pain usually are not caused by Bartholin's abscesses, seek emergency care if these symptoms do develop.

In general, the diagnosis of Bartholin's cyst or abscess is made by physical examination. In many cases, no additional testing is needed.

Sometimes cultures are taken to determine the type of bacteria causing the infection and to check for sexually transmitted infections such as gonorrhea and chlamydia. These cultures simply involve taking a swab either from the material drained from the abscess or from another area such as the cervix. Results of these tests are not available until about 48 hours later, so they do not change the immediate treatment. However, they may indicate a need for additional treatment with antibiotics.

Treatment of a Bartholin's cyst usually includes sitz baths to promote drainage, and sometimes includes surgical drainage depending on the severity of the symptoms. Doctors sometimes prescribe antibiotics.

• For a small Bartholin's cyst that is not too painful, treatment consists of sitz baths with follow-up if the cyst enlarges or becomes painful.
• Especially with recurrent cysts treatment with antibiotics and sitz baths to cool off the infection is sometimes done. If this clears up the infection, a surgical procedure called a marsupialization can be done later.

Home treatment of Bartholin's cysts and abscesses involves sitz baths, which promote drainage. Special sitz bath basins are available, but the simplest method is to sit in the bathtub in a few inches of warm water. The water should not be so hot as to burn the skin, but it should be fairly warm. These soaks should be done for 10-15 minutes at a time, 3-4 times daily.

• This treatment is frequently all that is needed for Bartholin's cysts.
• Abscesses often require drainage from a doctor.

• For Bartholin's abscesses and cysts that are symptomatic (large or painful), the treatment is drainage. An abscess is an infection within an enclosed space, and antibiotics do not adequately enter the enclosed space. Therefore, treatment of an abscess almost always requires that the infection be drained.
  • Drainage of a Bartholin's abscess can be done in the doctor's office or a hospital's Emergency Department. A local anesthetic is injected over the abscess, and then an incision is made on the inner surface of the entrance to the vagina. After the infected material is drained, the abscess cavity is packed either with gauze or a small catheter. This holds the cavity open and promotes further drainage. Gauze packing is removed after 24-48 hours. If a small catheter is used, it may be left in place for several weeks to minimize the chance of recurrence. The catheter is the preferred method of drainage because it is less painful and more successful.
  • Drainage of an abscess can be uncomfortable because local anesthetics do not always work well in inflamed tissue. Depending on the preferences of both the woman and the doctor, as well as other factors including the size of the abscess, IV medications may be given for sedation and additional pain relief during the procedure.
  • After drainage of an abscess, antibiotic treatment is usually not necessary. However, if there is a concern of a sexually transmitted infection, or if there is evidence of urinary or vaginal infection, an antibiotic may be prescribed. In some cases, this will be done a couple of days after the initial treatment, after the results of any cultures are received.

Once a recurrent cyst has been cooled off, a procedure called marsupialization can be carried out. This is usually done in an outpatient surgical setting. An incision is made into the skin over the cyst and then carried down through the cyst wall. This drains the fluid from the cyst and then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent drain site. This usually prevents the recurrence of the cyst.

• Women who have had a Bartholin's cyst or abscess drained should follow up in 24-48 hours for a recheck and possible removal of packing material. In the meantime, sitz baths should be taken to continue drainage.
• Contact the doctor if the packing falls out prematurely. Depending on the timing, the size of the abscess, and whether symptoms are continuing, it may or may not need to be replaced.
• Women may be given pain medication. Take this as prescribed. If antibiotics were prescribed, they should be taken until gone.
• Women should be rechecked if they experience new symptoms including increasing swelling, pain, vaginal discharge, or fever.

• If a Bartholin's cyst develops, prompt treatment with sitz baths may prevent the development of an abscess.
• Safe sex practices can decrease the spread of sexually transmitted diseases and therefore prevent the formation of abscesses caused by these organisms.

The majority of women feel much better within 24 hours of drainage. Some have problems with recurrent cysts or abscesses. If that occurs, the entire Bartholins gland can be excised.  A gynecologist most often performs this procedure.