Bartholin's Cyst Flashcards
Define
CYST: Non-infectious occlusion of the distal Bartholin’s duct, with resultant retention of secretions.
- The paired Bartholin’s ducts are located at the posterior vestibule and provide a conduit for secretions from the Bartholin’s glands.
Epidemiology
- These are the MOST COMMON types of vulval cysts
Aetiology
BARTHOLIN’S CYST
- The Bartholin’s glands are at the entrance of the vagina. A cyst or abscess can form in the Bartholin’s duct (which drains the glands) if it becomes blocked or infected.
- Cysts arise in the duct system of Bartholin’s gland and are typically the result of occlusion of the main duct into the vestibule
- The glands provide a lubricating function during sexual intercourse and a moisturising effect on the vulval surfaces
- The cause of obstruction is typically obscure
- May occur secondary to mucus or trauma
- Can occur from infection and oedema compressing the duct
The size of the cyst depends on accumulation of gland secretions and is exemplified by RAPID ENLARGEMENT during sexual activity and shrinkage or stability of cyst size in women with diminished sexual activity
BARTHOLIN’S ABSCESS
- Most commonly results from polymicrobial non-gonorrhoeal infection of cyst fluid rather than primary infection of the gland or duct
- Bacteriodes SPP, E.coli, N.gonorrhoea
- Possible entry mechanism in ascending infection is a stenotic opening that is too small to allow emission of thick Bartholin’s gland mucus secretion
- May be a sterile abscess
Risk factors
Women of reproductive age
Previous Bartholin’s cyst
- Especially with prior treatment incomplete
- Prior treatment can cause scarring, stenosis of the duct opening
Sexual activity
Direct trauma or surgery
Overweight women
Symptoms and Signs
Unilateral labial swelling, often asymptomatic/painless
o Infected: Abscess with cardinal signs of infection
Presenting Symptoms
- 1-4cm swelling
- Vulval/ perineal mass
- Vulval pressure or fullness
- Pain during sitting or walking
- Dyspareunia
Signs O/E
- Vulval erythema and induration
- Spontaneous rupture
- Fever
Investigations
(n.b. if ≥40yo, consider a vulval biopsy) – clinical:
o If infected: MC&S from abscess – most are sterile but may help organism differentiation
Management
Conservative management – if ASYMPTOMATIC
- Soaking the cyst for 10 to 15 minutes in a few inches of warm water (it’s easier in the bath)- it’s best to do this several times a day for 3-4 days if possible
- Holding a warm compress (a flannel or cotton wool warmed with hot water) against the area
- Painkillers- paracetamol or ibuprofen
1st Line- Incision and Drainage and word catheter insertion
- Make an incision into the cyst
- Let the cyst drain out
- Word catheter insertion
- A permanent passage is created to drain any fluid that builds up in future
- The catheter can be removed about 4-6 weeks after the procedure
- Can occur in outpatient setting, done under local anaesthetic
NOTE: AB usually don’t work without I&D
Flucloxacillin, OD
1st line- Marsupialisation- MOST COMMONLY PERFORMED in the UK
- incision from base of abscess to surface
- Involves suturing into the cyst to let the fluid drain out
- Then stitches are placed at the edges to create a small ‘kangaroo pouch’
- This makes a permanent opening so that the gland can drain freely
- Usually done under GA or spinal anaesthesia
- Takes about 10-15 minutes, done as a day case
2nd line- Surgical excision
- Done if the above treatments have not worked or have recurring Bartholin’s cysts or abscesses
- Done under GA
Alternative Procedures
- Silver nitrate ablation (cauterisation)
- Carbon dioxide laser
- Needle aspiration
Broad spectrum antibiotics if abscess
Complications/ Prognosis
Complications
- Bartholin’s abscess
- Dyspareunia
Complications from procedures:
- Bleeding
- Bruising
- Infection
- Pain
- Scarring
Prognosis
- Treatment is successful in 85% patients
- More likely to get in future
- Recurrent abscesses/ cysts are more difficult to manage
- After gland-excision, there may be long-lasting effects of vaginal dryness or/and dyspareunia
PACES
PACES
Can immediately reassure that it is an infective process and nothing to worry but do want to biopsy to exc any risk of malignancy
