Bartholin's cyst Flashcards
What is the diagnosis?
Skene gland cyst
What is the diagnosis?
Bartholin’s cyst
Where are Bartholin’s cysts usually located?
Medially protruding cystic structure at the inferior aspect of the labia majora, in the 5 or 7 o’clock position, crossed by the labium minus.
Name 3 types of cysts taht can occur in the vulval area.
- Bartholin’s cysts
- Skene gland cysts
- mucous inclusion cysts
May or may not cause vulval discomfort.
What is the most common vulval cyst?
Bartholin’s cyst
How common are Bartholin’s cysts?
Affect 2% of women
Usually at age 20-50 years but most occur before 30 years old. Uncommon before puberty and after menopause.
What are the clinical features of a Bartholin’s cyst?
Sudden onset unilateral vulval swelling
Discomform following sexual activity - rapid enlargement in sexual activity and shrinkage/stability in women with less sexual activity.
In abscess: vulval pain unrelieved by analgesics, difficulty sitting down, mild pyrexia, erythematous vulva
What is the function of secretions from Bartholin’s gland?
- Lubricating during sexual intercourse
- Moisturising effect on vulval surfaces
What investigations are done for Bartholin’s cyst?
None - clinical diagnosis
In abscess, microscopy and culture of abscess materal for antimicrobial targets (but most cysts are sterile, and 33% of abscesses are sterile)
What are the most common organisms implicated in Bartholin’s abscess?
E coli (most common)
polymicrobial (second)
Staph aureus
GBS
Enterococi
What is the aetiology of Bartholin’s cyst?
The Bartholin’s gland has a long duct which, when blocked, causes fluid to build up and eventually forms a cyst.
If infected they cause Bartholin’s abscess that usually presents acutely and may require incision and drainage.
What is the management of Bartholin’s cyst?
Asymptomatic:
- Conservative - sitz baths and warm compresses to aid drainage.
Symptomatic:
- Marsupialisation - incision and drainage in acute presentation. Otherwise elective procedure done under GA or spinal anaesthetic.
- +/- broad spectrum antibiotics
- +/- catheter drainage - maintains cyst patency in outpatient drainage.
What is the management of Bartholin’s abscess?
- Analgesia - paracetamol 500-1000mg every 4-6 hours.
- Incision and drainage
- Broad-spectrum antibiotics
What is marsupialisation?
Marsupialization of the cyst = when the internal aspect of the cyst is sutured to the outside of the cyst to create a window so that the cyst does not reform; usually an elective procedure under GA or spinal.
Why is marsupialisation and not surgical excision the preferred treatment option?
Surgical excision –> absence of Bartholin’s gland –> vulval and vaginal dryness, itching, burning and dyspareunia.
But excision may be required for recurrent cysts.
