Bartholin's cyst

Question 1

Define Bartholin’s cyst.

Answer 1

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

Question 2

Where are Bartholin’s glands? What do they do?

Answer 2

Behind labia minora
4 + 8 o’clock positions
Secrete lubricating mucus for coitus.

Question 3

Explain the aetiology of Bartholin’s cyst.

Answer 3

Blockage of the duct

If infection occurs (usually E. coli, or Staph) an abscess forms.

Question 4

What are 4 risk factors for Bartholin’s cyst?

Answer 4

Nulliparous women of reproductive age.

Previous Bartholin’s cyst

Sexually active (STIs can cause a Bartholin’s cyst or abscess)

Hx of vulval surgery

Question 5

Give 4 symptoms of Bartholin’s cyst

Answer 5

Usually asymptomatic

If large: pain walking/ sitting

Superficial dyspareunia

If spontaneous rupture: sudden relief of pain

Question 6

Give 4 symptoms of Bartholin’s abscess

Answer 6

Acute onset pain
Pain walking/ sitting
Difficulty passing urine

Question 7

Describe Bartholin’s cyst on physical examination.

Answer 7

Soft, fluctuant + non-tender

Question 8

Give 3 signs of Bartholin’s abscess on examination

Answer 8

Tense + hard, with surrounding cellulitis
Red, swollen, hot
Fever

Question 9

What are the investigations for Bartholin’s cyst or abscess?

Answer 9

Clinical dx

Swab if infection suspected

Endocervical + high vaginal swab if STI suspected

If >40y biopsy should be considered (esp. if there are solid components)– to exclude vulval carcinoma.

Question 10

Describe management for Bartholin’s cyst/ abscess

Answer 10

Asymptomatic: warm baths or compresses to aid drainage

Symptomatic: word catheter or Marsupialisation

Question 11

Compare word catheter and Marsupialisation management techniques for Bartholin’s cyst/ abscess

Answer 11

WC: LA, incision into cyst, catheter inserted + drains for 4-6w

M: GA, incision, drainage + cyst wall everted + approximated to vaginal mucosa

Question 12

What additional management is required for Bartholin’s abscess?

Answer 12

BS Abx: Trimethoprim/ Sulfamethoxazole combo

Question 13

Identify 4 complications of Bartholin’s cyst/ abscess management.

Answer 13

Infection
Recurrence.
Dysuria
Dyspaeurnia

Question 14

When may Bartholin’s glands be removed?

Answer 14

If other Tx not effective + Bartholin’s cysts or abscesses keep recurring
Or
If suspected malignancy