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What is Bartholin’s Cyst and Abscess?

The Bartholin’s glands and its ducts are located deep in the posterior (back) third of the labia, on either side of the vagina. It secretes thin lubricating mucus, especially at the time of sexual excitation. The glands are small and cannot be felt normally but when the ducts are blocked, a painless cyst may develop. Infection within the cyst may lead to abscess formation which can become extremely painful. Bartholin’s cyst and abscess usually develop in women between the ages of 20 and 30 years.

Causes of Bartholin’s Cyst and Abscess

A cyst is a collection of fluid within a closed sac. Obstruction of the duct leading out of Bartholin’s gland results in accumulation of secretions within the gland. This leads to a painless swelling of the gland, known as Bartholin’s cyst. Infection is an important cause of obstruction. Sometimes, obstruction may be due to congenital (birth defect) narrowing of the duct.

An abscess is a collection of pus in any part of the body, which usually causes swelling and inflammation around it. Infection of a Bartholin’s cyst results in an abscess. This infection may be caused by a number of bacteria, including those causing sexually transmitted diseases (STD) such as chlamydia and gonorrhea, and those residing normally in the intestines such as Escherichia coli (E coli). More than one type of organism may be involved in abscess formation.

Signs and Symptoms of Bartholin’s Cyst and Abscess

A Bartholin’s cyst is usually painless. Swelling of the labia may be felt on one side, close to the vagina. A small cyst often regresses on its own within a few days without any specific treatment.

A Bartholin’s abscess may be extremely painful, making it difficult for the person to walk comfortably or sit down.

• Dyspareunia or pain during intercourse is likely.
• The labia on one side may be hugely swollen, red, and hot.
• The surrounding tissues may become swollen and inflamed. Fever may or may not be present but vaginal discharge is possible, particularly when the infection is caused by a sexually transmitted organism.
• There may be sudden relief of pain followed by discharge in case of spontaneous rupture of the abscess.

Diagnosis of Bartholin’s Cyst and Abscess

A physical examination will usually diagnose a Bartholin’s cyst or abscess. Culture of the drained pus may be done to identify the type of organism involved and to exclude STD. In postmenopausal women, a biopsy may be done to exclude cancer.

Treatment of Bartholin’s Cyst and Abscess

• Small, noninflamed cysts, without any symptoms, do not usually need any treatment.
• Sitz bath treatment, or sitting in a basin or bathtub of hot (tolerable) water for 10 to 15 minutes 3 to 4 times a day, may give relief and promote drainage of the cyst or abscess.
• Incision and drainage of the infected cyst or abscess is the usual method of treatment. However, a simple incision and drainage can only give temporary relief since the opening tends to become blocked again, resulting in recurrent cysts and infection. The preferred treatment is incision of the infected cyst or abscess and permanent drainage by means of marsupialization, where the inner cyst wall is folded back and stitched to the overlying skin. Recurrence of Bartholin’s cyst may be prevented by this method of treatment.
• Sometimes, after an incision and drainage procedure, a Word catheter is inserted in the abscess cavity and left in place for several weeks so as to ensure complete drainage till the area heals.
• Appropriate antibiotics are given as indicated.