Bartholin's cyst

Question 1

Define Bartholin’s cyst.

Answer 1

A non-infectious occlusion of the distal Bartholin’s duct, with resultant retention of secretions.

Question 2

Explain the aetiology of Bartholin’s cyst.

Answer 2

Bartholin’s glands (two) sit behind the labia minora and secrete lubricating mucus for coitus.

Blockage of the duct causes cyst formation.

In infection occurs (usually with staphylococcus or Escherichia coli) an abscess forms.

Question 3

What are the risk factors for Bartholin’s cyst?

Answer 3

Woman of reproductive age.

Previous Bartholin cyst/abscess: if initial treatment incomplete; repetitive procedures may result in duct orifice narrowing and scarring, making recurrence more likely

Sexual activity (causes cyst to enlarge)

Rarely, cyst or abscess may occur after episiotomy, trauma, or vulvovaginal surgery

Question 4

Summarise the epidemiology of Bartholin’s cyst.

Answer 4

Typically occur in sexually active women of reproductive age.

Most cases occur between age 20-50 years (72% before age 30; only 10% >40 years)

Question 5

Recognise the presenting symptoms of Bartholin’s cyst.

Answer 5

When infected, acute pain and tender large red swelling

Medially protruding cystic structure at the inferior aspect of the labia majora in the 5 or 7 O’clock position, and is crossed by the labium minus

Vulval pressure or fullness

Pain during sitting or walking

Dyspareunia (if large cyst obscures the introitus)

Question 6

Recognise the signs of Bartholin’s cyst on physical examination.

Answer 6

1/3 have a fever

Vulval erythema and induration

Spontaneous rupture (uncommon)

Question 7

Identify appropriate investigations for Bartholin’s cyst and interpret the results.

Answer 7

Microscopy and culture of abscess material

• 80% cultures from cysts are sterile
• 33% cultures from abscesses are sterile
• May help identify antimicrobial treatment when resolution is incomplete after incision and drainage

Biopsy of vulval lesion:

• If malignancy is suspected on clinical examination
• Considered in women >40y with a Bartholin’s cyst/abscess given increased incidence of Bartholin’s gland cancer among menopausal women.

Question 8

Generate a management plan for Bartholin’s cyst.

Answer 8

Asymptomatic cyst (conservative management)

-Small, quiescent, asymptomatic cysts can be managed with sitz baths or warm compresses to aid drainage

Symptomatic cyst (surgical) - excised

Abscesses are treated conservatively unless they are ruptured so give broad spectrum antibiotics e.g. trimethoprim/sulfamethoxazole.

Question 9

Identify the possible complications of Bartholin’s cyst and its management.

Answer 9

• Dyspareunia after treatment
• Vulval dryness
  Bartholin’s rectal fistula

Question 10

Summarise the prognosis for patients with Bartholin’s cyst.

Answer 10

Recurrence rate after marsupialisation is 2-25%

Abscess after incision and drainage recurs in 15% cases