Bartholin's Cyst and Abscess

What problems can arise from Bartholin's glands?

Bartholin's cyst

If the tube (duct) that drains the fluid becomes blocked then a fluid-filled swelling (cyst) develops. The size of a cyst can vary from small and pea-like to the size of a golf ball, or even bigger in some cases. The cyst may remain the same size or may slowly become bigger. The reason why a Bartholin's duct may become blocked and lead to a cyst is not clear.

Bartholin's abscess

An abscess is a collection of pus that can occur with an infection. An abscess can occur in a Bartholin's gland. Sometimes an abscess develops from a Bartholin's cyst that becomes infected. Sometimes the gland itself becomes infected and forms into an abscess. Within a few days, the abscess can become the size of a hen's egg, sometimes larger, and is usually very painful.

Many types of germs (bacteria) can infect a Bartholin's cyst or gland to cause an abscess. Most are the common germs that cause skin or urine infections, such as Staphylococcus spp. and Escherichia coli. So, any woman can develop a Bartholin's abscess. Some cases are due to sexually transmitted germs such as gonorrhoea or chlamydia.

Bartholin's gland cancer

This is a very rare cancer and is very unlikely in women aged under 40. However, if there is any doubt about the cause of the swelling, a small sample of tissue (biopsy) can be checked.

Who develops Bartholin's cysts and abscesses?

About 3 in 100 women will develop a fluid-filled swelling (Bartholin's cyst) or a collection of pus (Bartholin's abscess) at some point in their lives. So, they are a common problem. Most cases occur 'out of the blue' in women aged between 20 and 30. However, they can also occur in older or younger women.

Symptoms of Bartholin's cysts and abscesses

As mentioned earlier, a fluid-filled swelling is a Bartholin's cyst. A collection of pus is an Bartholin's abscess. A Bartholin's cyst or abscess typically only develops on one of the two glands.

• If a cyst remains small and does not become infected then you may have no symptoms.
• You may just feel a small lump to one side at the lower end of the entrance to the vagina, which may cause no problems.
• However, a larger cyst may cause some discomfort - in particular, when walking, sitting, or having sex. Very large cysts can become quite painful.

With a Bartholin's abscess:

• A lump develops and quickly becomes bigger, typically over a few hours or days.
• It is likely to become very painful.
• There may be a build-up of white or yellow pus in the gland.
• You may feel unwell and have a high temperature; the skin over the abscess tends to become red, hot and very tender.
• The tender swelling makes it painful to sit down, to walk or to have sex.
• Some women may also have some vaginal discharge.

How are Bartholin's cysts or abscesses diagnosed?

An examination by a doctor can usually diagnose the problem. A Bartholin's cyst (fluid-filled swelling) and collection of pus (abscess) have a typical appearance. No test is usually needed to make the diagnosis.

Sometimes a sample of the pus inside an abscess may be taken (a swab). This is sent to the laboratory to find out which germs are causing the infection. This helps the doctors choose the right antibiotics if these are needed.

Bartholin's cyst treatment

If you have a small Bartholin's cyst or fluid-filled swelling that causes no symptoms and does not become infected, it may be best simply to leave it alone. However, you should always report a 'lump' in the area around your vagina (your vulva) to your doctor. Do not just assume a small lump is a Bartholin's cyst. It is best for a doctor to examine you to confirm the diagnosis and to rule out other causes of lumps in the vulva. If a cyst causes symptoms then it can be treated.

A collection of pus, confirmed as a Bartholin's abscess, will almost always need treatment, as it can be very painful. However, if an abscess is left for long enough it is likely to burst and then may resolve without treatment. This is not recommended though, as it will be very painful and you could become quite ill.

Antibiotic medicines for an infection or abscess

A course of antibiotics may cure an infected gland or abscess. However, the more pus that forms, the larger the abscess, and the less chance that antibiotics alone will be sufficient to clear the abscess. In large abscesses, usually it is necessary to drain the pus. Where this is done, antibiotics may or may not also be needed.

A small operation is needed in many cases

The main aim of the operation is to drain any fluid or pus. This relieves symptoms. In addition, another aim is to minimise the chance of the problem happening again (recurring).

Marsupialisation
A small operation called marsupialisation is the traditional treatment used to treat a Bartholin's cyst or abscess. It may be done under general anaesthetic. It can also be done under local anaesthetic when the overlying skin is numbed with an injection of local anaesthetic. A small cut (incision) is made into the cyst or abscess just inside the entrance to the vagina. Any fluid or pus drains out. The cut is widened to about 1 cm. A few stitches are then used to stitch the inside lining of the cyst to the overlying skin. This then creates a small new permanent opening for fluid to drain out of the gland.

Initially, the opening that is left is like a pouch - hence the name of the operation. However, the opening gradually becomes smaller and soon the opening becomes tiny and not noticeable. This new opening becomes a new tube (duct) which allows any fluid that is made by the gland to drain.

A course of antibiotics may be prescribed if pus is drained from an abscess. However, antibiotics are not always needed once the pus has been drained.

Marsupialisation is usually successful. In only a few cases the problem comes back if this procedure is done. If a simple cut is made to drain the fluid or pus without then doing a marsupialisation, there is a high chance that the problem will come back at some point.

As with all operations there is a small chance of problems. For example, infection of the wound occurs in a small number of cases following marsupialisation.

Other types of operation
In recent years, various other procedures have been introduced which are sometimes used instead of marsupialisation. For example:

• Insertion of a Word catheter. This is a small, thin rubber tube. The head of the catheter is inserted through a small cut made into the cyst or abscess. The tip of the catheter has a tiny balloon which is blown up to keep the catheter in place for 2-6 weeks. Whilst the catheter is in place you can go about your normal activities. The aim is to keep the opening from closing up. As the tissues heal, it allows the cells to form a new tube (duct) over the catheter.
• Insertion of a Jacobi ring. This too is a thin catheter that is passed into the cyst or abscess through one small cut and out from a separate cut. The two ends of the catheter are tied together with a silk thread that goes through the middle of the catheter. As with a Word catheter, this is left in place for a few weeks to allow a new duct to form.

The operation chosen depends on factors such as the size of the cyst or abscess and the preference and expertise of the surgeon. They all usually work well, with a low rate of recurrence.

Other techniques

Some people recommend that sitting in a warm bath for 10-20 minutes, three or four times a day, may encourage a Bartholin's cyst to burst naturally. It is not clear how well this may work. However, it is always best to see a doctor if you think an abscess is developing.

Other less commonly used procedures include application of silver nitrate to an abscess cavity and use of a carbon dioxide laser.

Sometimes the entire gland is removed by a surgical operation. This is considered a 'last resort' but may be advised if you have several recurrences of a Bartholin's cyst or abscess.

Will it happen again?

In most cases, a Bartholin's fluid-filled swelling (cyst) or collection of pus (abscess) does not happen again after treatment with one of the operations described above. If antibiotics alone cured the problem, or if the abscess is simply drained, there is more chance of it happening again at some point. Treatment may need to be repeated, or another type of treatment used.

Cases due to sexually transmitted infections

If you have a Bartholin's gland infection or abscess, a swab (a small ball of cotton wool on the end of a thin stick, used to take a sample) of the area or a sample of pus is usually sent to the laboratory. This is to identify which germ (bacterium) caused the infection. If a sexually transmitted germ is the cause of the infection then further screening for other sexually transmitted infections for yourself and your partner will usually be advised.

Can Bartholin's cysts or abscesses be prevented?

Not usually. Most occur 'out of the blue' for no apparent reason. Some Bartholin's abscesses are due to sexually transmitted infections and so using a condom when having sex may prevent some cases.