Bartholin's Cyst

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked, resulting in fluid accumulation and cyst formation. These cysts can range from being asymptomatic to causing significant discomfort during activities such as walking and sexual intercourse. Rarely, an abscess may form if the cyst becomes infected.

Introduction

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked, resulting in fluid accumulation and cyst formation. These cysts can range from being asymptomatic to causing significant discomfort during activities such as walking and sexual intercourse. Rarely, an abscess may form if the cyst becomes infected.

Signs and Symptoms

Most Bartholin's cysts do not cause any symptoms. When symptoms do occur, they may include pain during walking, sitting, or sexual intercourse (dyspareunia). The cysts are typically between 1 and 4 cm in size and are located just medial to the labia minora. They usually affect only one side (unilateral). While small cysts are usually not painful, larger cysts can cause significant pain.

Pathophysiology

A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked, possibly due to an infection or a mucus plug. This blockage leads to the retention of glandular secretions, forming a cyst.

Diagnosis

The diagnosis of a Bartholin's cyst is primarily based on clinical symptoms and examination. Differential diagnoses include conditions like sebaceous cysts, hernias, hidradenitis suppurativa, folliculitis, vulvar cancer, haematoma, gonorrhoea, syphilis, and genital warts. In women over the age of 40, a biopsy is often recommended to rule out cancer.

Treatment

If the cyst is asymptomatic, no treatment may be necessary. Conservative management includes sitz baths, which can help in draining minor cysts by soaking the vaginal area in warm water for ten minutes up to four times per day.

For symptomatic cysts, more invasive treatments are available. The preferred method is the placement of a Word catheter for about four weeks. This catheter allows continuous drainage and helps form a new duct opening. If this method fails, marsupialisation, a surgical procedure to create a permanent opening, may be considered. Antibiotics are generally not required unless there is an infection, in which case common antibiotics like Doxycycline and Azithromycin may be used.

In cases where the cyst recurs frequently or becomes severely infected, the entire gland may be surgically removed, especially in women over 40 to rule out cancer. It is important to note that while Word catheterisation and marsupialisation have similar recurrence rates, the latter may require more frequent use of analgesics.

Prognosis

While Bartholin's cysts can be painful, they are not life-threatening. Surgical or laser removal of a cyst reduces the likelihood of recurrence at the same site, but new cysts can still form. A randomised control trial (the WoMan trial) found similar recurrence rates between Word catheter and marsupialisation treatments, with recurrence occurring in 12% of women in the catheter group and 10% in the marsupialisation group.

Epidemiology

Bartholin's cysts affect approximately 2% of women at some point in their lives. They occur at a rate of 0.55 per 1000 person-years and are most common in women aged 35–50 years, at a rate of 1.21 per 1000 person-years. The incidence increases with age until menopause and decreases thereafter. Hispanic women may be more often affected than white and black women. The risk of developing a Bartholin's gland cyst increases with the number of childbirths.

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Self-assessment MCQs (single best answer)

What is a Bartholin's cyst?

Which symptom is most commonly associated with a Bartholin's cyst?

Where are Bartholin's cysts typically located?

What is the primary method for diagnosing a Bartholin's cyst?

What is the preferred treatment method for symptomatic Bartholin's cysts?

Under what circumstance is a biopsy recommended for Bartholin's cysts?

Which of the following is NOT a differential diagnosis for a Bartholin's cyst?

What is marsupialisation?

At what age range are Bartholin's cysts most common?

What is the recurrence rate of Bartholin's cysts treated with Word catheterisation according to the WoMan trial?