Bartholin 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).
Bartholin gland 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. Methicillin-resistant Staphylococcus aureus (MRSA) is becoming more common in such infections (and in other vulvar infections).
Vulvar cancers rarely originate in Bartholin glands.
Symptoms and Signs
Most Bartholin gland 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.
Cellulitis with localized erythema and tenderness may develop. 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
Treatment
In women < 40, asymptomatic cysts do not require treatment. Mild symptoms may resolve when sitz baths are used. Otherwise, symptomatic cysts may require surgery.
Abscesses also 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:
Recurrent cysts may require excision.
In women > 40, newly developed cysts should be surgically biopsied (to exclude vulvar cancer) or removed. Cysts that have been present for years and have not changed in appearance do not require biopsy or surgical removal unless symptoms are present.
Abscesses are sometimes also treated with oral antibiotic regimens that cover MRSA (eg, trimethoprim 160 mg/sulfamethoxazole 800 mg twice a day or amoxicillin/clavulanate 875 mg twice a day for 1 week) plus clindamycin (300 mg 4 times a day for 1 week). Oral antibiotics should be used when cellulitis is also present; antibiotics should be chosen based on that region's antibiogram. Inpatient admission for IV antibiotics should be strongly considered if patients have poorly controlled diabetes mellitus or are immunocompromised.
Key Points
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For most Bartholin gland cysts, the cause of ductal obstruction is unknown; rarely, cysts result from a sexually transmitted disease.
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Cysts may become infected, often with MRSA, and form an abscess.
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In women > 40, biopsy newly developed cysts to exclude vulvar cancer or remove them.
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If cysts cause bothersome symptoms, treat surgically (eg, with catheter insertion, marsupialization, and/or excision).
