A Bartholin's cyst is a fluid-filled sac within the Bartholin's gland of the vagina. Bartholin's cysts typically occur in nulliparous women of child-bearing age and other risk factors include a personal history of Bartholin's cyst, being sexually active, or a history of vulval surgery. Bartholin's cysts can cause vulvar pain, dyspareunia, and may rupture spontaneously, relieving pain. Treatment options include incision and drainage with placement of a Word catheter or marsupialization to prevent reaccumulation of fluid.

1. Mrs Agnes Mahima David
Asst.Prof

2. 
A Bartholin’s cyst is a fluid-filled sac within one of the
Bartholin’s glands of the vagina
Definition

3. 
 Bartholin’s cysts characteristically occur
in nulliparous women of child-bearing age. Other
risk factors include:
 Personal history of Bartholin’s cyst
 Sexually active (STIs can cause a Bartholin’s cyst or
abscess)
 History of vulval surgery
Risk Factors

4. 
 Small Bartholin’s cysts are often asymptomatic. If
they become large, they can cause vulvar pain
(particularly when walking and sitting),
and superficial dyspareunia (pain during sexual
intercourse).
 The cyst can undergo spontaneous rupture – after
which the patient typically experiences a sudden
relief of pain.
 Bartholin’s abscesses typically present with acute
onset of pain, and/or difficulty passing urine.
Clinical Features

5. 
 On examination, a unilateral labial mass will be
observed. This typically arises from the posterior
aspect of the labia majora, although a large cyst or
abscess can expand anteriorly.
 Bartholin’s cyst – typically soft, fluctuant and non-
tender
 Bartholin’s abscess – typically tense and hard, with
surrounding cellulitis

6. 
 The differential diagnosis for a mass in the labial or
vulval region includes:
 Bartholin’s gland carcinoma – primary carcinoma is
rare (approximately 0.1-5% of vulvar malignancies).
 Bartholin’s benign tumour – such as adenomas and
nodular hyperplasia. These are rarer than Bartholin’s
carcinoma.
 Other types of cyst – e.g. sebaceous cyst, Skene’s
duct cyst, mucous cyst
 Other solid masses – e.g. fibroma, lipoma, leiomyom
Differential Diagnosis

7. 
 the diagnosis of a Bartholin’s cyst or abscess is often
a clinical one, and further investigations are not
routinely required.
 However – if the woman is over 40 years of age, a
biopsy of the cyst should be considered (especially if
there are solid components to the swelling) – this is
to exclude vulval carcinoma.
 If there are any indications of a sexually transmitted
infection, endocervical and high vaginal swabs
should be taken.
Investigations

8. 
 If the cyst is small and asymptomatic, no treatment is required.
Warm baths can be recommended to the patient, as they may
stimulate spontaneous rupture.
 Treatment is usually by Word Catheter or marsupialisation. There
is no high quality evidence comparing different treatment options.
However, simple incision and drainage without marsupialisation
or placement of a Word catheter means that the accumulation of
fluid is likely to reoccur (due to further outflow obstruction).
 Word Catheter – an incision is made into the cyst or abscess, and a
catheter is inserted. The tip is inflated with 2-3ml of saline. It is left
in place for 4-6 weeks to allow epithelisation of the surgically
created tract. This technique is not suitable for deep cysts or
abscesses. It can be performed under local anaesthesia in a clinic.
 Complications include infection, recurrence, dyspareunia and
scarring.

9. 
 marsupialisation – a 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 good marsupialisation
 Complications include bleeding/haematoma, dyspareunia and
infection.
 Less commonly used techniques include silver nitrate cautery,
carbon dioxide laser and needle aspiration. Complete excision of
the gland is rarely performed – and usually only in cases of
suspected malignancy.
 There is no evidence to routinely pack the cavity after any of
these procedures.