Bartholin's cyst

The Bartholin's (BAHR-toe-linz) glands are located on each side of the vaginal opening. These glands secrete fluid that helps lubricate the vagina.

Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin's cyst. If the fluid within the cyst becomes infected, you may develop a collection of pus surrounded by inflamed tissue (abscess).

A Bartholin's cyst or abscess is common. Treatment of a Bartholin's cyst depends on the size of the cyst, how painful the cyst is and whether the cyst is infected.

Sometimes home treatment is all you need. In other cases, surgical drainage of the Bartholin's cyst is necessary. If an infection occurs, antibiotics may be helpful to treat the infected Bartholin's cyst.

If you have a small, noninfected Bartholin's cyst, you may not notice it. If the cyst grows, you might feel a lump or mass near your vaginal opening. Although a cyst is usually painless, it can be tender.

A full-blown infection of a Bartholin's cyst can occur in a matter of days. If the cyst becomes infected, you may experience:

• A tender, painful lump near the vaginal opening
• Discomfort while walking or sitting
• Pain during intercourse
• Fever

A Bartholin's cyst or abscess typically occurs on only one side of the vaginal opening.

Call your doctor if you have a painful lump near the opening of your vagina that doesn't improve after two or three days of self-care — for instance, soaking the area in warm water (sitz bath). If the pain is severe, make an appointment with your doctor right away.

Also call your doctor promptly if you find a new lump near your vaginal opening and you're older than 40. Although rare, such a lump may be a sign of a more serious problem, such as cancer.

Experts believe that the cause of a Bartholin's cyst is a backup of fluid. Fluid may accumulate when the opening of the gland (duct) becomes obstructed, perhaps caused by infection or injury.

A Bartholin's cyst can become infected, forming an abscess. A number of bacteria may cause the infection, including Escherichia coli (E. coli) and bacteria that cause sexually transmitted infections such as gonorrhea and chlamydia.

A Bartholin's cyst or abscess may recur and again require treatment.

There's no way to prevent a Bartholin's cyst. However, safer sex practices — in particular, using condoms — and good hygiene habits may help to prevent infection of a cyst and the formation of an abscess.

To diagnose a Bartholin's cyst, your doctor may:

• Ask questions about your medical history
• Perform a pelvic exam
• Take a sample of secretions from your vagina or cervix to test for a sexually transmitted infection
• Recommend a test of the mass (biopsy) to check for cancerous cells if you're postmenopausal or over 40

If cancer is a concern, your doctor may refer you to a gynecologist who specializes in cancers of the female reproductive system.

Often a Bartholin's cyst requires no treatment — especially if the cyst causes no signs or symptoms. When needed, treatment depends on the size of the cyst, your discomfort level and whether it's infected, which can result in an abscess.

Treatment options your doctor may recommend include:

• Sitz baths. Soaking in a tub filled with a few inches of warm water (sitz bath) several times a day for three or four days may help a small, infected cyst to rupture and drain on its own.

• Surgical drainage. You may need surgery to drain a cyst that's infected or very large. Drainage of a cyst can be done using local anesthesia or sedation.

  For the procedure, your doctor makes a small incision in the cyst, allows it to drain, and then places a small rubber tube (catheter) in the incision. The catheter stays in place for up to six weeks to keep the incision open and allow complete drainage.

• Antibiotics. Your doctor may prescribe an antibiotic if your cyst is infected or if testing reveals that you have a sexually transmitted infection. But if the abscess is drained properly, you may not need antibiotics.
• Marsupialization. If cysts recur or bother you, a marsupialization (mahr-soo-pee-ul-ih-ZAY-shun) procedure may help. Your doctor places stitches on each side of a drainage incision to create a permanent opening less than 1/4-inch (about 6-millimeter) long. An inserted catheter may be placed to promote drainage for a few days after the procedure and to help prevent recurrence.

Rarely, for persistent cysts that aren't effectively treated by the above procedures, your doctor may recommend surgery to remove the Bartholin's gland. Surgical removal is usually done in a hospital under general anesthesia. Surgical removal of the gland carries a greater risk of bleeding or complications after the procedure.

Daily soaking in warm water, several times a day, may be adequate to resolve an infected Bartholin's cyst or abscess.

After a surgical procedure to treat an infected cyst or abscess, soaking in warm water is particularly important. Sitz baths help to keep the area clean, ease discomfort and promote effective drainage of the cyst. Pain relievers also may be helpful.

Your first appointment will likely be with either your primary care provider or a doctor who specializes in conditions that affect women (gynecologist).

What you can do

To prepare for your appointment:

• Write down your symptoms, including any that seem unrelated to your condition.
• Make a list of any medications, vitamins or supplements that you take along with the dosages.
• Take a notebook or notepad with you to write down information during your visit.
• Prepare questions to ask your doctor, listing the most important questions first to be sure you cover them.

For a Bartholin's cyst, some basic questions to ask include:

• What's likely causing my symptoms?
• What kind of tests might I need?
• Will the cyst go away on its own, or will I need treatment?
• How long should I wait after treatment before having sex?
• What self-care measures might help relieve my symptoms?
• Will the cyst come back again?
• Do you have any printed material or brochures I can take home with me? What websites do you recommend?

Don't hesitate to ask other questions during your appointment as they occur to you.

What to expect from your doctor

Some potential questions your doctor might ask include:

• How long have you had symptoms?
• How severe are your symptoms?
• Do you experience pain during sex?
• Do you experience pain during normal daily activities?
• Does anything improve your symptoms?
• Does anything make your symptoms worse?