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Bartholin's
gland cysts are mucus-filled and occur on either side of the vaginal
opening. They are the most common large vulvar cysts. Symptoms of
large cysts include vulvar irritation, dyspareunia, pain with walking,
and vulvar asymmetry. Bartholin's cysts may form abscesses, which
are painful and usually red. Diagnosis is by physical examination.
Large cysts and abscesses require drainage with or without excision;
abscesses sometimes require antibiotics.
Bartholin's glands are round, very small, nonpalpable, and located deep in the posterolateral vaginal orifice. Obstruction of the Bartholin duct causes the gland to enlarge with mucus, resulting in a cyst. Cause of obstruction is usually unknown. Rarely, the cysts result from a sexually transmitted disease (eg, gonorrhea). A cyst may become infected, forming an abscess.
Symptoms,
Signs, and Diagnosis
Most cysts are asymptomatic, but large cysts can be irritating, interfering with intercourse and walking. Most cysts are nontender, unilateral, and palpable near the vaginal orifice. Cysts distend the affected labia majora, causing vulvar asymmetry. Abscesses cause severe vulvar pain and sometimes fever; they are tender and typically erythematous.
Diagnosis is usually by physical examination. Vulvar cancers (see Gynecologic Tumors: Vulvar Cancer), some of which develop from Bartholin's glands, may resemble cysts. Consequently, cysts are biopsied in women > 40.
Treatment
In women < 40, asymptomatic cysts do not require treatment. Symptomatic cysts may require surgery. Because cysts often recur after simple drainage, surgery aims to produce a permanent opening from the duct to the exterior. A small balloon-tipped catheter may be inserted, inflated, and left in the cyst for 4 to 6 wk; this procedure stimulates fibrosis and produces the permanent opening. Another procedure is marsupialization (suturing the everted edges of the cyst to the exterior). Recurrent cysts may require excision. In women > 40, all cysts require exploration and biopsy. Abscesses are treated with oral broad-spectrum antibiotics (eg, cephalexin 500 mg q 6 h for 7 to 10 days) and insertion of a balloon-tipped catheter.
Last full review/revision November 2005
Content last modified November 2005
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