Bartholin's cyst

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Bartholin's cyst
Classification and external resources
Barthonlincyst2011.png
Bartholin's cyst of the right side
ICD-10 N75.0
ICD-9 616.2
MedlinePlus 001489

A Bartholin's cyst is formed when a Bartholin's gland is blocked. They maybe from the size of a pea to the size of an egg and form just within each side of the lower part of the opening of the vagina. An abscess may form if the cyst becomes infected.[1] In this case it often becomes red and painful when touched.[1]

A Bartholin's cyst is not an infection, although it can be caused by an infection, inflammation, or physical blockage (mucus or other impediment) to the Bartholin's ducts (tubes which lead from the glands to the vulva). If infection sets in, the result is a Bartholin's abscess. Cysts are not sexually transmitted. There is no known reason for their development and infection is rare. With an abscess, a bacterial infection but usually not an STD is the cause.[2]

Treatment depends on the severity of symptoms. It their are no symptoms no treatment may be needed. If the cysts is causing problems than drainage is recommended. The prefered method of drainage is the insertion of a catheter known as a Word catheter for four weeks as with simply incision and drainage the cyst may reform. A surgical procedure known as marsupialization may also be used for cysts but should not be used if they are infected. If the problems continues to come back, removal of the entire gland may be performed. This is also sometimes recommended in those older than 40 to make sure there is no cancer. Antibiotics are not generally needed.[1]

Bartholin's cysts are most likely in women of child-bearing age. About two percent of women having the problem at some point in time.[1]

Signs and symptoms[edit]

Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[1] or sexual intercourse (dyspareunia).[3] 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). If the cyst is small usually there is no pain involved. If the cyst becomes very large, it can cause significant pain.

Pathophysiology[edit]

In order for a Bartholin's gland cyst to develop, the duct that drains the cyst must become blocked.[3] This blockage may occur due to an infection or a mucus plug.[3] The secretions from the Bartholin's gland are retained, and a cyst forms.[1]

Diagnosis[edit]

Other conditions that may present similarly include hidradenoma papilliferum, lipomas, epidermoid cysts and Skene's duct cysts among others.[1] In those who are more than 40 years of age a biopsy may be recommended to made sure cancer is not present.[1]

Treatment[edit]

Treatment may not be necessary, when Bartholin's cysts cause no symptomatic. Small, asymptomatic cysts should simply be observed over time to see if they grow. For cases where intervention is necessary, 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, for the achievement of absence of swelling and discomfort and the appearance of a freely draining duct.[4]

Catheterization is a minor procedure and can be performed in an office setting. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.[1] The balloon is than 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. The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.

Cysts may also be opened permanently, a method called marsupialization,[5] in which an opening to the gland is formed with stitches which hold the secretion channel open.

If the 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. Warm compresses can speed healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.

Prognosis[edit]

While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming; however, surgical or laser removal of a cyst makes it less likely that a new one will form at the same site. However, those with a cyst are more likely than someone else 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.

Epidemiology[edit]

Two percent of women will have a Bartholin's gland cyst at some point in their lives.[1] 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.[6] The incidence of Bartholin duct cysts increase with age until menopause, decreasing thereafter.[6] White and black women may be less often affected than Hispanic women.[1] The risk of developing a Bartholin's gland cyst increases with the number of childbirths.[1]

References[edit]

  1. ^ a b c d e f g h i j k l Omole, F; Simmons, BJ; Hacker, Y (Jul 1, 2003). "Management of Bartholin's duct cyst and gland abscess". American family physician 68 (1): 135–40. PMID 12887119. 
  2. ^ Marx, John A. Marx (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed. ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN 1455706051. 
  3. ^ a b c 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. 
  4. ^ Bartholin's cyst from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013
  5. ^ 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. 
  6. ^ a b Yuk, JS; Kim, YJ; Hur, JY; Shin, JH (2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 122 (1): 62–4. doi:10.1016/j.ijgo.2013.02.014. PMID 23618035. 

External links[edit]