Bartholin Gland Cyst

What is a Bartholin gland cyst?

The Bartholin glands are two pea-sized organs that are located under the skin in a woman's genital area. They are on either side of the folds of skin (labia) that surround the vagina and urethra. Normally, you cannot feel or see the Bartholin glands.

The Bartholin glands produce a small amount of fluid that moistens the outer genital area, or vulva. This fluid comes out of two tiny tubes that are located next to the opening of the vagina. These are called Bartholin ducts.

A Bartholin gland cyst is a blockage of the duct and a buildup of fluid in the gland. (Sometimes it is called a Bartholin duct cyst.) Bartholin gland cysts can range in size from a small marble to the size of an orange. They usually grow slowly. An infected Bartholin gland or duct is called a Bartholin gland abscess.

Uncommonly, both Bartholin glands can be affected at the same time.

Bartholin gland cysts are often small and painless, and to not require treatment. Some go away without treatment. You need to think about treatment only if a cyst is causing symptoms. Getting treatment is important when an infection has set in.

What are the symptoms of a Bartholin gland cyst or abscess?

• If a Bartholin gland cyst is not infected, a painless lump in the vulva area is the most common symptom. You may notice redness or swelling in the vulva area. A cyst can swell from 0.25 in. (0.64 cm) up to 3 in. (7.62 cm). You may find the cyst on your own, or your health professional may notice it during a physical exam.
• If a Bartholin gland cyst becomes infected, it forms an abscess that can grow in size over 2 to 4 days and is usually very painful. If extreme pain limits your activities, even walking or sitting, then the gland probably is infected. Some abscesses will break open and start to heal on their own after 3 to 4 days.

What causes a Bartholin gland cyst?

A genital infection, inflammation, or thickened mucus can block a Bartholin duct.¹ When this happens, fluid builds up inside and creates a Bartholin gland cyst. Sexual stimulation triggers more fluid production, which makes the cyst bigger.¹

Is it possible to prevent a Bartholin gland cyst?

It is not possible to prevent Bartholin gland cysts.

Infected Bartholin cysts are sometimes caused by sexually transmitted diseases (STDs). You can lower your risk of infection by using a condom when you have sex.

How are Bartholin gland cysts treated?

You can see your gynecologist or family health professional for treatment. A Bartholin gland cyst that is big enough to cause symptoms is usually drained. To keep the cyst from closing and filling up again, a tiny opening is made and kept open for a few weeks. Once the area has healed, the opening remains. This usually prevents the cyst from coming back.

At home, you can take a nonprescription pain medication such as ibuprofen (Advil, Motrin) if necessary. To help healing, soak the area in a shallow, warm bath, or sitz bath. Do not have sex while a Bartholin cyst is healing.

An infected cyst is drained and treated with antibiotics. Draining relieves most of the abscess pain.

For a Bartholin gland abscess that comes back several times, the gland and duct can be surgically removed.

Frequently Asked Questions

A small Bartholin gland cyst is most often symptom-free. However, a large cyst or infection can cause symptoms.

Bartholin gland cyst that is not infected

Symptoms may include:

• A painless lump in the vulva area. It is possible, though unlikely, for both glands to develop cysts at the same time.
• Redness or swelling in the vulva area. A Bartholin gland cyst can swell from 0.25 in. (0.64 cm) up to 3 in. (7.62 cm).
• Discomfort when walking, sitting, or having sex.

You may find a Bartholin cyst on your own, or your health professional may notice it during a physical exam.

Infected Bartholin gland cyst (abscess)

Symptoms may include:

• Increasing pain that limits activities or occurs with walking, sitting, physical activity, or sex.
• Fever and chills.
• Swelling in the vulva area over a 2- to 4-day period.
• Drainage from the cyst.² Drainage may occur 4 to 5 days after the swelling starts.

An abscess that opens (ruptures) on its own should be checked by a health professional to prevent complications.

Complications of an abscessed Bartholin gland cyst are rare but include gangrene, necrotizing fasciitis, toxic shock, and sepsis.²

Unless a Bartholin gland cyst is causing symptoms, you may not know you have one. You or your health professional are most likely to notice one if it is big enough to be uncomfortable, creates a lump you can see or feel under the skin, or is infected.

If you are older than 40, your health professional may more carefully examine a lump to make sure that it is not cancerous. Although cancer is rare, a woman's risk increases with age.

A Bartholin gland abscess is diagnosed based on signs of infection, such as fever or swelling, and pain in the Bartholin gland area . Your health professional may culture some of the fluid drained from the abscess. Culture results show what type of bacteria are causing the infection. Knowing this helps with planning your antibiotic treatment. More than 60 different types of bacteria have been found in Bartholin gland abscesses, including gonorrhea and chlamydia.

Most Bartholin gland cysts don't need treatment, or they go away on their own. However, if you have a cyst that is causing bothersome symptoms or that may be infected, see your health professional for treatment. Your treatment options will depend on how severe your symptoms are.

Treatment for a Bartholin gland cyst that is not infected

When a Bartholin gland cyst appears, but there are no symptoms or mild symptoms, treatment includes:

• Watchful waiting. Symptoms are observed without using medical treatment. Some Bartholin cysts never get worse.
• Soaking the genital area in a warm, shallow bath (sitz bath). This can reduce discomfort and helps the genital area to heal.
• Nonprescription pain medication, such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve discomfort.

A Bartholin gland cyst can be present for months or years without causing any symptoms.

If sexual intercourse causes symptoms, see your health professional.

Treatment for a ruptured Bartholin abscess

An infected Bartholin gland cyst (abscess) that has burst open (ruptured) sometimes will heal on its own. In this case, your health professional may suggest sitz baths, nonprescription pain relievers, and watchful waiting. You may not need to take antibiotics once the cyst has ruptured.

Treatment for a Bartholin gland cyst that causes symptoms

A Bartholin cyst that is large, painful, or infected will be drained. If you have an abscess, you may take antibiotics before the procedure.

Simply draining a cyst and letting it heal shut will likely allow it to fill up again.² To keep the cyst from closing and filling up again, it is usually held open for a few weeks with:

• A small drainage tube with a small balloon on one end. The balloon is inflated inside the cyst to keep the tube in place. Once the gland has healed and the tube and balloon are removed, the opening remains. This is the most common way to treat a large or infected Bartholin gland cyst.
• Stitches, which prevent the cyst wall from reforming a closed sac. Bartholin gland cysts only recur about 10% to 15% of the time after this procedure.³

Less commonly, the cyst wall is damaged with a carbon dioxide laser or silver nitrate to prevent it from growing back.

Bartholin cyst treatment can be done with a local anesthetic in the doctor's office. However, a painful cyst is more likely to be surgically treated using general anesthesia.

For severe Bartholin cysts and abscesses that do not get better with repeated treatment, the entire Bartholin gland and duct can be removed. This is a surgery, also known as excision. Because excision is an involved procedure that can lead to blood loss and complications, it is done in a surgery center. Excision is only used when other treatments have repeatedly failed.

What to think about

To reduce the risk of infection after treatment, do not have sexual intercourse until the area is completely healed. This can take several weeks, depending on the treatment method that was used.

Excision is sometimes recommended for postmenopausal women who have Bartholin gland cysts or abscesses. This is because of general concerns about the risk of cancer in the pelvic area, which increases with age. However, simply draining a Bartholin cyst and testing the cyst tissue for cancer is also a reasonable first-time treatment for older women.

Treatment during pregnancy

If you are pregnant and have a Bartholin gland cyst, your treatment will depend on how severe your symptoms are and whether you have an infection.

• When possible, draining a cyst is delayed until after your baby is born. This is because the genital area has increased blood flow during pregnancy, so bleeding is more likely. However, a large cyst may need to be drained to prevent problems during delivery.
• Because having an infection can cause you to go into labor before your due date, an abscess is drained and treated with antibiotics. Antibiotics and local anesthesia are considered safe during pregnancy.

Watchful waiting and home treatment may be all that you need for a Bartholin gland cyst that has:

• No symptoms.
• Mild symptoms.
• Opened and drained on its own. (See your health professional to make sure that other treatment is not necessary.)

You can help relieve Bartholin gland cyst discomfort by taking warm sitz baths and nonprescription pain medication.

Call your health professional if your symptoms become worse or do not improve as expected. If you have signs of infection, such as fever, chills, pain, redness, or sudden swelling, see your health professional for treatment.

• Swollen Glands and Other Lumps Under the Skin
• Vaginal Yeast Infections

Citations

1. Eilber KS, Raz S (2003). Benign cystic lesions of the vagina: A literature review. Journal of Urology, 170(3): 717–722.

2. Toth PP (2000). Management of Bartholin's gland duct cysts and abscesses. In RE Rakel, ed., Saunders Manual of Medical Practice, 2nd ed., pp. 585–587. Philadelphia: W.B. Saunders.

3. Mou SM (2000). Gynecologic Infections. In VL Seltzer, WH Pearse, eds., Women's Primary Health Care, 2nd ed., chap. 28, pp. 232–233. New York: McGraw-Hill.

Other Works Consulted

• Droegemueller W (2001). Infections of the lower genital tract. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 645–647. St Louis: Mosby.

Author:	Kathe Gallagher, MSW	Last Updated April 4, 2005
Medical Review:	Martin Gabica, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information. For more information, click here.