Bartholin's Cyst / Nabothian Cysts Flashcards
Where are the Bartholin’s glands located?
- they are paired glands located either side of the posterior part** of the **vaginal introitus
- they are usually pea-sized and not palpable
- they secrete fluid to help with lubrication during sex
What is a Bartholin’s cyst and how does it occur?
- a unilateral fluid-filled cyst that is between 1-4cm in size
- occurs when the ducts become blocked
- this leads to swelling / tenderness of the Bartholin’s gland
What is a Bartholin’s abscess?
- this occurs when a cyst becomes infected
- an abscess will be hot, tender, erythematous + potentially draining pus
What is the management for a Bartholin’s cyst?
it will resolve with conservative management:
- good hygiene
- analgesia
- warm compresses
!! incision is avoided as the cyst tends to recur !!
- a biopsy is required to exclude vulval malignancy
- this is mainly in women > 40 years old
What is involved in the investigations for a Bartholin’s abscess?
- a swab is taken from the pus/fluid of the abscess
- the infective organism is cultured** and **antibiotic sensitivities can be identified
- swabs for chlamydia + gonorrhoea should also be taken
What is the most common causative organism of a Bartholin’s abscess?
E. coli
What is the first line management for a Bartholin’s abscess?
antibiotics
- this is guided from sensitivities identified from swab taking / culture
What are the 2 potential options for surgical management of a Bartholin’s abscess?
- word catheter (local anaesthetic)
- marsupialisation (general anaesthetic)
What is involved in the use of a Word catheter?
- it is a small rubber tube with a balloon at the end
- local anaesthetic is used to numb the area
- an incision is made to drain pus from the abscess
- the catheter is inserted into the abscess space and filled with 3ml saline
- the balloon fills the space to keep the catheter in place
- fluid drains around the catheter to prevent a cyst reoccurring
- tissue heals around the catheter, leaving a permanent hole
- the catheter can be deflated and removed once epithelialisation of the hole has occurred
What is involved in marsupialisation?
- this requires general anaesthetic / theatre
- an incision is made to drain the abscess
- the sides of the abscess are sutured open
- this allows for continuous drainage of the area and it prevents recurrence of the cyst
What is a Nabothian cyst?
- fluid-filled cysts on the surface of the cervix
- they can be up to 1cm in size
- they are completely harmless
Why do Nabothian cysts occur?
- the columnar epithelium of the endocervix produces mucus
- mucus can become trapped when the squamous epithelium of the ectocervix slightly covers that of the endocervix
- trapped mucus forms a cyst
- this occurs after childbirth, minor trauma or cervicitis after infection
How do Nabothian cysts typically present?
- they are usually found incidentally on speculum examination
- they usually do not cause symptoms
- they may cause a feeling of fullness in the pelvis if they are very large
How do Nabothian cysts appear on speculum examination?
- smooth rounded bumps on the cervix
- they are typically close to the os
- they are from 2mm - 30mm in size
- they have a whitish / yellowish appearance
What is the treatment for Nabothian cysts?
- if the diagnosis is clear, no treatment is required
- the woman is reassured that they do not cause harm and resolve spontaneously
If the diagnosis of a Nabothian cyst is uncertain, what is done?
colposcopy
- this allows the lesion to be examined in more detail
- sometimes, they can be excised / biopsied to exclude other pathology
- rarely, they can be treated during colposcopy to relieve symptoms
