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Image credit: Primary Care Dermatology Society, UK
It's usually not known why Bartholin’s ducts become blocked, but once a lump (cyst) has developed, the fluid inside can easily become infected. Usually, the infection is from bacteria commonly found in the vagina. However, sometimes bacteria that can cause sexually transmitted infections (such as gonorrhoea or chlamydia) cause the infection.
You might feel a lump or fluid-filled mass near your vaginal opening. This is usually painless but it can be tender. If the cyst becomes infected, you may experience:
Always see your GP if you find a lump in your vaginal region so they can confirm a diagnosis and ensure appropriate treatment is received. If your GP thinks the cyst may be infected, they may swab it and send a sample to the lab for analysis to identify the bacteria responsible. In some cases, your GP may recommend you have a biopsy (sample of tissue removed) so it can be checked for signs of a rare cancer, called Bartholin’s gland cancer.
Depending on the size of the cyst or abscess, and the severity of your symptoms, treatment options range from self-care and medication to drainage or surgical removal of the cyst.
Self-care
If you can feel the cyst, but it is not growing, sore or infected, it's unlikely you need any treatment. If the cyst is painful, your GP may recommend some simple self-care measures, such as:
Medication
If the cyst is infected (developed into an abscess), your doctor may prescribe antibiotics. If the abscess does not respond to antibiotics, you may need to have one of the following procedures.
Word catheter balloon insertion (procedure)
This procedure takes around 15 minutes and is carried out under a local anaesthetic. It involves making a channel from the cyst or abscess through which the gland can drain. A small cut is made in the abscess and a small flexible tube (catheter) with a small balloon at its tip is inserted to create a passage. It is usually offered to women under 40.
Marsupialisation (surgery)
This surgery is done under general anaesthetic and takes about 10–15 minutes. The doctor makes a small cut in the abscess and gland to release the fluid, sewing the edges to the surrounding skin. This keeps the cut open, so it can heal and for the abscess to drain out. This prevents another abscess from forming later. The small cut will completely heal by itself.
Excision (surgery)
This surgery involves the removal of the cyst or abscess under general anaesthetic. It is carried out so that the area can be fully examined when the cyst or abscess is removed. During excision, the entire gland is removed. This procedure is only considered in women over 40 who have had abscesses recur on several occasions. As result of excision, the gland will no longer function which means that your body will produce less lubricant.
This loss of lubrication can make having sex uncomfortable. To improve lubrication, you can use lubricants or vaginal moisturisers. If these are not effective for you, talk to your doctor about whether vaginal oestrogen and hormone replacement therapy (HRT) are suitable for you.
Because it's not clear exactly why Bartholin's cysts develop, it isn't usually possible to prevent them. However, some cysts are thought to be linked to sexually transmitted infections, so practising safe sex (using a condom every time you have sex) might help reduce your chances of developing one.
The following links provide further information about Bartholin’s cyst. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Bartholin's cyst and abscess(external link)(external link) Patient Info, UK, 2017
Bartholin’s cyst(external link)(external link) NHS, UK, 2015
Sitz bath(external link)(external link) Healthline, US, 2017
Treating a Bartholin's cyst or abscess [PDF, 96 KB] Treating a Bartholin's cyst or abscess Guys’ and St Thomas’ NHS Foundation Trust, UK, 2017
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
Although incision and drainage is the most frequently performed procedure, it is associated with a high rate of recurrence. Oral antibiotics are not indicated unless there is associated cellulitis or systemic symptoms. If required, broad-spectrum antibiotic cover is necessary as the infection is usually polymicrobial. Carcinoma of the Bartholin gland is rare (approximately 1% of genital malignancies in women), however, this diagnosis should be considered in a woman aged over 40 years. Vulvovaginal health in premenopausal women(external link)(external link) BPAC, NZ, 2011
Because the Bartholin's glands usually shrink during menopause, a vulvar growth in a postmenopausal woman should be evaluated for malignancy, especially if the mass is irregular, nodular, and persistently indurated. Omole F, Simmons BJ, Hacker Y. Management of Bartholin's duct cyst and gland abscess(external link)(external link) Am Fam Physician. 2003 Jul 1;68(1):135-140.
Bartholin's cyst(external link)(external link) BMJ Best Practice, UK, 2017
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Reviewed by: Dr Jeremy Tuohy
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