Bartholin's cyst and abscess

Question 1

What is a Bartholin’s cyst

Answer 1

A fluid filled sac within one of the Bartholin’s glands of the vagina

Question 2

What percentage of all gynaecological visits a year are due to Bartholin’s abscesses?

Answer 2

2%

Question 3

What percentage of women may have asymptomatic Bartholin’s cysts?

Answer 3

3%

Question 4

Where are Bartholin’s glands located?

Answer 4

Deep to the posterior aspect of the labia majora

Question 5

Where are the openings to Bartholin’s glands?

Answer 5

Either side of the vaginal orifice - 4 o’clock and 8 o’clock positions, just below the hymenal ring

Question 6

What is the purpose of the Bartholin’s glands?

Answer 6

They secrete mucus to lubricate the vagina

Question 7

Describe how a Bartholin’s cyst forms

Answer 7

Excess mucus secretions

Gland becomes blocked

Question 8

Describe how an abscess forms from a Bartholin’s cyst

Answer 8

Cyst becomes infected and if untreated develops into an abscess

Question 9

Which organisms commonly cause a Bartholin’s abscess

Answer 9

Aerobic - E.coli, MRSA and STIs

Question 10

Give some risk factors of Bartholin’s cysts

Answer 10

Nulliparous 
Child bearing age
Personal Hx of Bartholin's cysts 
Sexually active - STI
History of vulval surgery

Question 11

Describe the clinical features of Bartholin’s cysts

Answer 11

Small - asymptomatic
Large - vulval pain when walking and sitting, superficial dyspareunia
Spontaneous rupture - sudden relief of pain after

Question 12

Describe the clinical features of Bartholin’s abscesses

Answer 12

Acute onset of pain and/or difficulty passing urine

Question 13

What might be seen on examination of a Bartholin’s cyst or abscess?

Answer 13

Unilateral labial mass observed
Typically arises from the labia majora, although a large cyst or abscess can expand anteriorly

Bartholin’s cyst - typically soft, fluctuant and non-tender

Bartholin’s abscess - tense and hard with surrounding cellulitis

Question 14

What are the differentials for a mass in the labial/vulval region?

Answer 14

Bartholin’s gland carcinoma
Bartholin’s gland tumour - adenoma, nodular hyperplasia
Cyst - sebaceous cyst, skene’s duct cyst, mucous cyst
Solid mass - fibroma, leiomyoma, lipoma

Question 15

When are investigations for a Bartholin’s cyst considered?

Answer 15

Biopsy if there are solid components to the swelling and the woman is >40 years of age - exclude vulval carcinoma

Endocervical and high vaginal swabs if STI

Question 16

Describe the management of a Bartholin’s cyst?

Answer 16

If small and asymptomatic - hot bath advised to stimulate spontaneous rupture

Word catheter

Marsupialisation

Silver nitrate cautery

CO2 laser

Needle aspiration

Question 17

Describe word catheter

Answer 17

Incision is made into the cyst or abscess and a catheter is inserted, the tip is inflamed with 2-3ml of saline, left in place for 4-6 weeks to allow epitheliasation of the surgically created tract. Performed under local anaesthetic in clinic

Question 18

Describe marsupialisation

Answer 18

Vertical incision is made into the cyst, behind the hymenal ring, allowing for spontaneous drainage of the cavity
The cyst wall is then everted and approximated to the end of the vaginal mucosa by sutures, this requires a general anaesthetic to achieve goo marsupilaisation

Question 19

What are some complications of word catheter

Answer 19

Infection
Recurrence
Dyspareunia
Scarring

Question 20

What are some complication of marsupialisation?

Answer 20

Bleeding/haematoma
Dyspareunia
Infection

Question 21

When are antibiotics given to women with Bartholin’s cysts?

Answer 21

Can be considered if the patient is systemically unwell or immunocompromised