[39] Bartholin's Cyst and Abscess Flashcards
What is a Bartholin’s cyst?
A fluid-filled sac within one of the Bartholin’s glands in the vagina
What % of gynaecological visits in the UK per yea rare due to Bartholin’s cysts and abscesses?
2%
In what % of women do asymptomatic Bartholin’s cysts occur?
Up to 3%
What are the Bartholin’s glands also known as?
Greater vestibular glands
Where are the Bartholin’s glands located?
Either side of the vaginal orifice, within the vestibule of the vagina (approx 4 and 8 o’clock positions), just below the hymenal ring
What is the function of Bartholin’s glands?
They secrete mucus to lubricate the vagina
What can cause the Bartholin’s gland to become blocked?
The build-up of mucus secretions
What can happen to the Bartholin’s cyst?
It can become infected, and if untreated develop into an abscess
What organisms infect the Bartholin’s cyst?
Usually anaerobic, including;
- E. Coli
- MRSA
- STIs
Who do Bartholin’s cysts most commonly occur in?
Nulliparous women of child-bearing ge
What are the risk factors for Bartholin’s cysts?
- Personal history of Bartholin’s cyst
- Sexually active
- History of vulval surgery
When are Bartholin’s cysts often asymptomatic?
If they are small
What symptoms can large Bartholin’s cysts cause?
- Vulvar pain
- Superficial dyspareunia
When in particular do Bartholin’s cysts cause vulvar pain?
When walking or sitting
Can Bartholin’s cysts undergo spontaneous rupture?
Yes
What is experienced when Bartholin’s cysts undergo spontaneous rupture?
Sudden relief of pain
How do Bartholin’s abscesses’ present?
- Acute onset of pain
- Difficulty passing urine
What will be found on examination in Bartholin’s cyst?
Unilateral labial mass, typically arising from posterior aspect of labia major
What are the features of a Bartholin’s cyst on examination?
- Soft
- Fluctuant
- Non-tender
What are the features of a Bartholin’s abscess on examination?
- Tense and hard
- Surrounding cellulitis
What are the differential diagnoses for a mass in the labial or vulval region?
- Bartholin’s gland carcinoma
- Bartholin’s benign tumour
- Other types of cyst
- Other solid masses
How common is a primary tumour of the Bartholin’s gland?
Rare, approx 0.1-5% of vulvar malignancies
Give two examples of Bartholin’s benign tumours
- Adenomas
- Nodular hyperplasia
What other types of cysts are differentials for Bartholin’s cysts?
- Sebaceous cyst
- Skene’s duct cyst
- Mucous cyst
What other solid masses are differentials for Bartholin’s cysts?
- Fibroma
- Lipoma
- Leiomyoma
How is the diagnosis of Bartholin’s cyst or abscess made?
Often clinical. and further investigations not routinely required
When might investigations be required in Bartholin’s cyst or abscess?
In women over 40 years of age
What investigation should be considered in suspected Bartholin’s cyst/abscess in women over 40?
Biopsy
When especially should biopsy of Bartholin’s cyst/abscess be considered in women over 40?
If there are solid components to the swelling
Why should a biopsy be considered in women over 40 with suspected Bartholin’s cyst/abscess?
To exclude vulva carcinoma
What investigation should be done if there is any indication of STI in Bartholin’s cyst/abscess?
Endocervical and high vaginal swabs
What management is required in Bartholin’s cyst that are small and asymptomatic?
None
What can be recommended to patients with Bartholin’s cysts that are small and asymptomatic?
Take warm baths, as this may stimulate spontaneous rupture
What are the commonly used treatment options for Bartholin’s cysts?
- Word Catheter
- Marsupilation
Why is simple incision and drainage of Bartholin’s cysts not recommended?
As accumulation of fluid is likely to reoccur due to further outflow obstruction
How is a Word Catheter inserted?
An incision is made into the cyst or abscess, and a catheter is inserted. The tip is inflated with 2-3ml of saline
How long is a Word Catheter left in situ?
4-6 weeks
Why is a Word Catheter left in situ for 4-6 weeks?
To allow for epithelialisation of the surgically created tract
What kind of Bartholin’s cysts is a Word Catheter not suitable for?
Deep cysts or abscesses
Does a Word Catheter require local or general anaesthetic?
Local
In what setting is a Word Catheter inserted?
Clinic
What are the complications of insertion of a Word Catheter?
- Infection
- Recurrence
- Dyspareunia
- Scarring
How is marsupialisation performed?
A vertical incision is made into the cyst, behind the hymenal ring, allowing for spontaneous drainage of the cavity. The cyst wall is then everted and approximated to the end of the vaginal mucosa by sutures
Is marsupialisation performed under local or general anaesthetic?
General
What are the less commonly used treatment options for Bartholin’s cyst/abscess
- Silver nitrate cautery
- Carbon dioxide laser
- Needle aspiration
- Complete excision of gland
When is complete excision of the gland performed in Bartholin’s cyst/abscess?
Rarely. only in cases of suspected malignancy
Are antibiotics used in the management of Bartholin’s cyst/abscess?
No, but can be considered if patient is systemically unwell or immunocompromised
