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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 during 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 and sometimes 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).

These cysts develop in about 2% of women, usually those in their 20s. With aging, cysts are less likely to develop.

A cyst may become infected, forming an abscess. Vulvar cancers rarely originate in Bartholin's glands (see Gynecologic Tumors: Vulvar Cancer).

Symptoms and Signs

Most cysts are asymptomatic, but large cysts can be irritating, interfering with sexual intercourse and walking. Most cysts are nontender, unilateral, and palpable near the vaginal orifice. Cysts distend the affected labia majora, causing vulvar asymmetry.

Bartholin's Cyst

Abscesses cause severe vulvar pain and sometimes fever; they are tender and typically erythematous. A vaginal discharge may be present. Sexually transmitted diseases may coexist.

Diagnosis

• Clinical evaluation

Diagnosis is usually by physical examination. A sample of discharge, if present, may be tested for sexually transmitted diseases. In women > 40, excisional biopsy must be done to exclude vulvar cancer.

Treatment

• Surgery for symptomatic cysts and those in women > 40

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. Usually, one of the following is done:

• Catheter insertion: 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 a permanent opening.
  Marsupialization: The everted edges of the cyst are sutured to the exterior.

Recurrent cysts may require excision.

In women > 40, all cysts must be surgically explored and removed by excisional biopsy.

Abscesses are treated with oral broad-spectrum antibiotics (eg, cephalexin Some Trade Names
KEFLEX
KEFTAB
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500 mg q 6 h for 7 to 10 days) and insertion of a balloon-tipped catheter.

Last full review/revision December 2008 by S. Gene McNeeley, MD

Content last modified December 2008