Nabothian and Bartholin’s Cysts

Question 1

Nabothian Cysts

Answer 1

Fluid-filled cysts often seen on the surface of the cervix

Question 2

Pathophysiology of nabothian cysts

Answer 2

Columnar epithelium of the endocervix produces cervical mucus.

Squamous epithelium of the ectocervix slightly covers the mucus-secreting columnar epithelium, the mucus becomes trapped and forms a cyst.

Question 3

When do nabothian cysts normally occur

Answer 3

After childbirth

Minor trauma to the cervix or cervicitis secondary to infection

Question 4

Presentation of nabothian cysts

Answer 4

Asymptomatic - incidental finding on speculum

If large - feeling of fullness in the pelvis

Question 5

Appearance of nabothian cysts

Answer 5

Smooth rounded bumps on the cervix, usually near to os.

Have a whitish or yellow appearance.

Question 6

Management of nabothian cysts

Answer 6

Reassurance - resolve spontaneously

Question 7

If the diagnosis of nabothian cyst is unclear

Answer 7

Colposcopy

Excision and biopsy (occasionally)

Question 8

Bartholin’s glands

Answer 8

Pair of glands located either side of the posterior part of the vaginal introitus (the vaginal opening).

Usually pea-sized and not palpable.

Question 9

Role of bartholin’s glands

Answer 9

Produce mucus to help with vaginal lubrication

Question 10

Pathophysiology of Bartholin’s cyst

Answer 10

When the ducts become blocked, the Bartholin’s glands can swell and become tender

Question 11

Bartholin’s abscess

Answer 11

Infected bartholin’s cyst

Question 12

Presentation of bartholin’s abscess

Answer 12

Hot, tender, red and potentially draining pus

Question 13

Presentation of bartholin’s cyst

Answer 13

Unilateral swelling which is fluid filled

Question 14

Management

Answer 14

Supportive

• good hygiene
• analgesia
• warm compresses

Question 15

How to diagnose a bartholin’s cyst

Answer 15

History and examination

Question 16

When to do a biopsy for a Bartholin’s cyst

Answer 16

If vulval cancer is suspected

Particularly if over 40+

Question 17

Investigations for Bartholin’s abscess

Answer 17

Swab - microscopy, sensitivity and culture

Chlamydia and Gonorrhoea specific swabs

Question 18

What is the common causative organism for Bartholin’s abscess

Answer 18

E. Coli

Question 19

Management of Bartholin’s abscess

Answer 19

Word catheter (Bartholin’s gland balloon) – requires local anaesthetic

Marsupialisation – requires general anaesthetic

Question 20

Word catheter

Answer 20

Catheter inserted into the abscess space, and inflated

The balloon fills the space and keeps the catheter in place.

Fluid can drain around the catheter, preventing a cyst or abscess reoccurring.

The tissue heals around the catheter, leaving a permanent hole.

The catheter can be deflated and removed once epithelisation of the hole has occurred.

Question 21

Marsupialisation

Answer 21

Incision is made
and the abscess is drained.

The sides of the abscess are sutured open.

Allows continuous drainage of the area and prevents recurrence of the cyst or abscess