Bartholin Cyst: Causes, Symptom and Treatment

Introduction

The Bartholin glands are two small glands located on both sides of the vaginal opening. Their main job is to produce mucus that helps keep the vagina lubricated.

Sometimes, these glands can get blocked, and a Bartholin gland cyst can form. This cyst is a sac filled with fluid when the gland’s duct is obstructed.

Although these cysts are usually harmless and don’t cause major symptoms, they can lead to discomfort, pain, or infections in some people.

Bartholin gland cysts are fairly common, especially in women of childbearing age, particularly those aged 20 to 30.

Many cysts are symptomless and go away by themselves. However, larger cysts or those that become infected may need medical treatment. In some situations, surgery might be needed.

Causes of Bartholin Gland Cyst

Bartholin gland cysts happen when the duct becomes blocked, causing mucus to build up. This blockage stops the gland from draining properly.

Some reasons for this blockage include:

1. Infection: The most typical cause of blockage is infection, usually due to bacteria like E. coli, Streptococcus, or Staphylococcus. Engaging in sexual activity, especially with multiple partners or without protection, can raise the risk of these bacterial infections.
2. Trauma: Injuries to the vaginal area, such as during childbirth or from rough sexual activity, can result in swelling or blockage of the gland duct.
3. Inflammation: Conditions that cause general inflammation in the genital region, such as vaginitis or vulvovaginitis, may also contribute to duct blockage.
4. Congenital Issues: In rare cases, cysts can happen due to birth defects in the ducts. These issues are usually found in childhood or teenage years and can lead to ongoing cyst problems.
5. Hormonal Changes: Hormonal shifts, particularly during puberty or pregnancy, can influence the Bartholin glands and potentially cause duct blockages.
6. Poor Hygiene: Not maintaining good genital hygiene or using harsh products can hinder the normal drainage of the Bartholin glands, leading to blockage or infection.

Symptoms of Bartholin Gland Cyst

Most Bartholin gland cysts do not have symptoms and might not be noticeable.

However, when symptoms do appear, they can differ based on the cyst’s size, if there is an infection, or if complications arise.

Common symptoms of Bartholin gland cysts include:

• Painless Lump: The primary symptom is a painless, smooth, round lump near the vaginal opening. The cyst is usually small but can grow larger if the blockage continues.
• Pain and Tenderness: Sometimes, the cyst can cause discomfort, particularly if it enlarges. The pain might be worse while sitting, walking, or during intercourse.
• Swelling: The region around the cyst may swell, especially if the cyst gets bigger or becomes infected.
• Redness: If the cyst gets infected and forms an abscess, the skin around it might become red or inflamed.
• Abscess Formation: In serious situations, the cyst can become infected and turn into an abscess, typically leading to more pain, fever, and pus drainage.
• Painful Intercourse: Bigger or infected cysts may cause pain or discomfort during sexual activity due to pressure on the vaginal walls.
• Fever and Chills: If the Bartholin gland cyst becomes infected, fever and chills can occur. and turns into an abscess, then symptoms like fever, chills, and overall discomfort could arise.

Risk Factors for Bartholin Gland Cyst

Various factors may raise the chance of getting a Bartholin gland cyst:

• Age: These cysts are more frequent in women who are of reproductive age, mostly between 20 and 30 years old. They tend to decrease after menopause due to lower hormone levels.
• Sexual Activity: Women who are sexually active, particularly those with multiple partners or not practicing safe sex, face a higher risk for Bartholin gland cysts because of possible bacterial infections.
• Lack of Good Hygiene: Women who don’t keep good genital hygiene or use strong cleaning agents may have a higher chance of infections and blockages in the ducts.
• Vaginal Infection History: If a woman has a past of frequent vaginal infections, such as vaginitis or pelvic inflammatory disease (PID), she may be at an increased risk for Bartholin gland cysts since inflammation and infections can clog the Bartholin duct.
• Health Issues: Some health issues, like diabetes or immune system problems, can weaken the body’s ability to resist infections, raising the odds of cysts or abscesses forming.
• Hormonal Changes: Changes in hormone levels during pregnancy or due to birth control can disrupt how the Bartholin glands work and help cysts form.

Differential Diagnosis

Several other conditions can show symptoms like Bartholin gland cysts, so it’s critical to distinguish them from other causes of genital lumps or discomfort.

The differential diagnosis includes:

• Bartholin Gland Abscess: If a cyst gets infected, it might turn into an abscess, showing signs like more pain, redness, swelling, and pus. This requires a different treatment, often involving drainage or antibiotics.
• Vaginal Cysts: Other cysts, like Gartner duct cysts or epithelial inclusion cysts, can develop in the walls of the vagina or cervix. These might be confused with a Bartholin gland cyst but are in different locations and may need different treatments.
• Lipoma: A lipoma, or benign fatty tumor, could show up as a painless bump in the genital area. Lipomas feel soft and can move, and they typically do not get infected or swollen like a Bartholin gland cyst.
• Sebaceous Cyst: A sebaceous cyst, caused by blocked sebaceous glands, might show up as a lump close to the vaginal opening. These are usually rarer in this area and generally aren’t linked with infections.
• Vulvar Cancer: Although it’s rare, a lump near the vaginal opening might suggest vulvar cancer. This condition usually comes with a tough, non-movable mass, and may include pain, bleeding, or changes in the skin.
• Herpes Simplex Virus (HSV) Infection: Genital herpes can show up as painful blisters or sores close to the vaginal opening. These lesions usually come with pain, burning, and itching, which are not common for Bartholin gland cysts.
• Abscess from Other Infections: Abscesses in the genital region can occur from infections not related to the Bartholin glands, such as those from Staphylococcus or Streptococcus bacteria. These infections might seem similar, yet typically need different treatments.

Investigation

Determining if someone has a Bartholin gland cyst is usually simple by a physical exam.

Yet, if there’s doubt about the diagnosis or worries about infection or complications, more tests might be needed:

• Physical Examination: The doctor will do a pelvic exam to feel the cyst and check its size, place, and sensitivity. The cyst usually feels smooth, round, and is found just inside the vaginal opening, at either the 4 or 8 o’clock positions.
• Microbial Culture: If an infection is thought to be present, a sample of any fluid or pus from the cyst may be collected for bacterial testing. Culture: This helps find the germ causing the problem and directs treatment.
• Imaging: Rarely, imaging tests like ultrasound or MRI might be done to check the cyst size and rule out other issues like tumors or abscesses.
• Biopsy: If the cyst is big, long-lasting, or possibly cancerous, a biopsy might be done to check the tissue for cancer.

Treatment of Bartholin Gland Cyst

The treatment for Bartholin gland cysts relies on the cyst’s size, if it causes symptoms, and if there are complications such as infection. Treatment choices include:

1. Conservative Management:

Warm Sitz Baths: A simple home remedy for small, non-painful cysts is soaking in warm water multiple times daily. This can help reduce swelling and may allow drainage if the cyst breaks.

Pain Relief: Over-the-counter painkillers like ibuprofen or acetaminophen can ease discomfort caused by the cyst.
Incision and Drainage: If the cyst gets infected and creates an abscess, a healthcare provider might need to drain the pus to relieve pressure. This procedure is done with local anesthesia, and antibiotics may be given for the infection.

2. Marsupialization:

For frequent Bartholin gland cysts or abscesses, a method called marsupialization can be used. This involves making a small cut in the cyst to allow ongoing drainage and stop it from refilling. The edges are sewn to nearby tissue to make a permanent drainage opening.

3. Surgical Removal:

For cysts that do not go away or cause problems, surgical removal of the Bartholin gland may occur. This is usually for more serious cases, as it has risks like bleeding or scarring.

4. Antibiotics:

If an infection exists, oral or topical antibiotics might be given to tackle the bacterial infection. Antibiotics are crucial when an abscess is present or if the cyst gets infected with Staphylococcus or Streptococcus germs.

5. Hormonal Therapy:

In rare cases, if cysts relate to hormone changes, hormonal treatments (like birth control pills) may help control the hormone imbalance.

Conclusion

A Bartholin gland cyst is a common and usually harmless issue that can cause discomfort or pain if it grows or becomes infected.

While many cysts naturally heal without treatment, larger or symptomatic ones may need medical attention, ranging from simple methods like warm sitz baths to more complex treatments like drainage or surgery.

Quick diagnosis and effective management can help reduce symptoms, prevent issues, and enhance the quality of life for those with Bartholin gland cysts.