Barthoin's Cysts and Abscesses Flashcards
What is a Bartholin’s cyst?
Definition – fluid filled sac in one of the Bartholin’s glands of the vagina
Also known as the greater vestibular glands – located deep in the posterior aspect of the labia majora. A build up of mucus secretions can cause the gland to block forming a cyst or abscess.
What organisms usually cause bartholin’s cysts?
Usually aerobic – E.coli, MRSA and STI’s
What are the risk factors for bartholin’s cysts?
Usually occur in nulliparous women
Previous history of Bartholin’s cysts
Sexually active
History of Vulval surgery
How do Bartholin’s cysts usually present?
Usually asymptomatic especially when small
Acute onset vulvar pain (when walking and sitting)
Superficial dyspareunia
Difficulty passing urine
Unilateral labial mass
Sudden rupture can cause sudden relief of the pain
Cyst – typically soft, fluctuant and non-tender
Abscess – typically tense, hard and surrounding cellulitis
What differentials are important to consider in suspected bartholian cysts
Bartholin’s tumour – benign or carcinoma
Other cysts – sebaceous cyst or Skene’s duct cyst
Other mass – fibroma, lipoma or leiomyoma
How should a suspected Bartholin’s cysts be investigated?
Clinical diagnosis
STI check
Biopsy if over 40
How should Bartholin’s cysts be managed conservatively
Asymptomatic – no treatment, warm baths to stimulate rupture
Antibiotics if obviously infected or STI
How can Bartholin’s cysts be managed surgically and what are the complications of these procedures?
Word catheter – incision made into the wound and a catheter inserted. Tip inflated with 2-3ml of saline and then left for 4-6 weeks. This allows epithelisation of the hole to prevent recurrence.
Marsupialisation – vertical incision made into the cyst to allow drainage. Cyst wall then everted and sutured to the vaginal mucosa. This requires GA.
Complications of either procedure include haemorrhage, haematoma, dyspareunia and infection
