Bartholins Cyst

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Introduction

Introduction

A Bartholin's cyst, also called a Bartholin's duct cyst, is a small fluid-filled sac just inside the opening of a woman's vagina.

You may feel a soft, painless lump. This doesn't usually cause any problems.

However, if the cyst grows very large, it can become noticeable and uncomfortable. You may feel pain in the skin surrounding the vagina (vulva) when you walk, sit down or have sex.

The cyst can sometimes affect the outer pair of lips surrounding the vagina (labia majora). One side may look swollen or bigger than usual.

If the cyst becomes infected, it can cause a painful collection of pus (abscess) to develop in one of the Bartholin's glands. Signs of an abscess include the affected area becoming red, swollen, tender and hot. It can also cause a high temperature of 38C (100.4F) or above.

When to see your GP

Small Bartholin's cysts are sometimes only found during a routine cervical screening test or an examination carried out for another reason.

Always see your GP if you develop a lump in the area around your vagina so they can confirm a diagnosis and rule out more serious conditions.

If your GP thinks the cyst or one of your Bartholin's glands may be infected, they may use a swab to remove a sample of discharge for analysis to identify the bacteria responsible.

In some cases, your GP may recommend you have a biopsy. A small sample of cyst tissue will be removed and examined under a microscope to check for signs of a rare type of vulval cancer called Bartholin's gland cancer.

What causes Bartholin's cysts?

The Bartholin's glands are a pair of pea-sized glands found just behind and either side of the lips that surround the entrance to the vagina. The glands aren't usually noticeable because they're rarely larger than 1cm (0.4 inches) across.

The Bartholin's glands secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes called ducts, into the vagina. If the ducts become blocked, they can fill with fluid and expand to form a cyst.

It's often not known why the ducts become blocked, but some cases are linked to sexually transmitted bacterial infections such as gonorrhoea or chlamydia, or other bacterial infections such as Escherichia coli (E. coli).

How Bartholin's cysts are treated

If you don't have any noticeable symptoms, it's unlikely you'll need treatment.

If the cyst is painful, your GP may recommend some simple self care measures, such as soaking the cyst in warm water several times a day for three or four days and taking over-the-counter painkillers.

If these don't work, several treatments are available to treat the pain and any infection. If necessary, the cyst can be drained. Most of these treatments involve a minor surgical procedure.

It's estimated a Bartholin's cyst will return at a later stage in about one in every five women treated for the condition.

Read more about treating a Bartholin's cyst.

Who's affected?

Around 1 in every 50 women will develop a Bartholin's cyst or abscess at some point. It usually affects sexually active women aged between 20 and 30.

Bartholin's cysts don't usually affect children because the Bartholin's glands don't start functioning until puberty. The cysts are also uncommon after the menopause as this usually causes the Bartholin's glands to shrink.

Preventing Bartholin's cysts

It's not clear exactly why Bartholin's cysts develop, so it isn't usually possible to prevent them.

However, as some are thought to be linked to sexually transmitted infections (STIs), practising safe sex (using a condom every time you have sex) can help reduce your chances of developing one.

Read more advice about STIs.

Treating a Bartholin's cyst

Treating a Bartholin's cyst

If you have a lump in your genitals, get it checked by your GP.

If it turns out to be a Bartholin's cyst and it doesn't bother you, it's often better to leave it alone.

If the cyst is painful, your GP may recommend:

  • soaking the cyst for 10 to 15 minutes in a few inches of warm water (it's easier in the bath) - it's best to do this several times a day for three or four days if possible
  • holding a warm compress (a flannel or cotton wool warmed with hot water) against the area
  • taking painkillers, such as paracetamol or ibuprofen

Always read the manufacturer's instructions when using over-the-counter medication.

Treating an abscess

If the cyst becomes infected and an abscess (a painful collection of pus) develops, you may be prescribed antibiotics to clear the infection.

Once the infection has been treated, your GP may still recommend having the cyst drained, particularly if the abscess is large.

Draining cysts and abscesses

A number of techniques can be used to drain a Bartholin's cyst or abscess and reduce the likelihood of it returning. The main procedures are described below.

Balloon catheter insertion

Balloon catheter insertion, sometimes known as catheter placement or fistulisation, is a procedure used to drain the fluid from the abscess or cyst.

A permanent passage is created to drain away any fluid that builds up in the future. This is an outpatient procedure, which means you won't need to stay in hospital overnight.

It's usually carried out under local anaesthetic, where you remain conscious, but the area is numbed so you can't feel anything. It can also be carried out under general anaesthetic, where you're unconscious and unable to feel anything.

A cut is made in the abscess or cyst and the fluid is drained. A balloon catheter is then inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

Once inside the abscess or cyst, the balloon is filled with a small amount of salt water. This increases the size of the balloon so it fills the abscess or cyst. Stitches may be used to partially close the opening and hold the balloon catheter in place.

The catheter will stay in place while new cells grow around it (epithelialisation). This means the surface of the wound heals, but a drainage passage is left in place. 

Epithelialisation usually takes around four weeks, although it can take longer. After epithelialisation, the balloon will be drained and the catheter removed.

A few small studies have reported more than 80% of women healed well and their cysts or abscesses didn't return after balloon catheter insertion.

Possible complications of balloon catheter insertion include:

  • pain while the catheter is in place
  • pain or discomfort during sex
  • swelling of the lips around the opening of the vagina (labia)
  • infection
  • bleeding
  • scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used.

The cyst is first opened with a cut and the fluid is drained out. The edges of the skin are then stitched to create a small "kangaroo pouch", which allows any further fluid to drain out.

When the procedure is complete, the treated area may be loosely packed with special gauze to soak up fluid from the wound and stop any bleeding. This will usually be removed before you go home.

Marsupialisation takes about 10 to 15 minutes and is usually performed as a day case procedure, so you won't have to stay in hospital overnight. It's usually carried out under general anaesthetic, although local anaesthetic can be used instead.

Although complications after marsupialisation are rare, they can include:

  • infection
  • the abscess returning
  • bleeding
  • pain - you may be given painkillers for the first 24 hours after the procedure

After marsupialisation, you'll be advised to take things easy for a few days. You should avoid having sex until the wound has completely healed, which usually takes about two weeks.

Removing the Bartholin's gland

Surgery to remove the affected Bartholin's gland may be recommended if other treatments haven't been effective and you have repeated Bartholin's cysts or abscesses.

This operation is usually carried out under general anaesthetic and takes about an hour to complete. You may need to stay in hospital for two or three days afterwards.

Risks of this type of surgery include bleeding, bruising and infection of the wound. If the wound does become infected, this can usually be treated with antibiotics prescribed by your GP.

Alternative procedures

There are a number of alternative ways of treating a Bartholin's cyst, but they're less commonly used or aren't widely available. These are described below.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used in medicine to burn (cauterise) blood vessels to stop bleeding. A small, solid stick of silver nitrate is used in silver nitrate gland ablation.

A cut is made in the skin surrounding your vagina 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 empty space left after draining the fluid.

The silver nitrate causes the cyst cavity to form into a small, solid lump. After two or three days the silver nitrate and cyst remains are removed or may fall out on their own.

It's possible for the silver nitrate to burn some of the skin of your vulva when it's first used. One small study reported this occurs in about one in every five women who receive this treatment.

Carbon dioxide laser

A carbon dioxide laser can be used to create an opening in the skin of your vulva so the cyst can be drained.

The cyst can then be removed, destroyed using the laser, or left in place with a small hole to allow fluid to drain from it.

Needle aspiration

During needle aspiration, a needle and syringe are used to drain the cyst. It is sometimes combined with a procedure called alcohol sclerotherapy, where the cavity is filled with a 70% alcohol liquid after being drained. This is left in the cyst cavity for five minutes and then drained out.

Advice after surgery

To help your wound heal and reduce the risk of infection after surgery, you may be advised to avoid:

  • having sex and using tampons for up to four weeks
  • using perfumed bath additives for up to four weeks
  • driving or performing tasks that need careful attention for 24 to 48 hours after having a general anaesthetic