Bartholin’s Cyst

By Dr Charlotte Sidebotham

What is a Bartholin’s cyst?

In short, this is caused by a fluid-filled swelling (cyst) in a Bartholin’s gland. The gland produces liquid to keep the vagina from drying out, so when it gets blocked, the gland becomes filled with liquid. If this cyst then becomes infected, an abscess occurs.

Several different types of bacteria can infect a Bartholin’s cyst, including common bodily bacteria like Staphylococcus aureus, which is found on your skin, or Escherichia coli (E. coli), which is commonly found in the bowels. In some cases, bacteria from sexually transmitted infections such as chlamydia or gonorrhoea can also infect a Bartholin’s cyst.

Bartholin’s cysts are common, especially in young women. They occur far less often in women over 40. If you find a lump in your vaginal opening and you are older than 40, it is important that you see your doctor straight away. Even though this is rare, it could be the sign of a more serious problem like cancer.

What are the symptoms of a Bartholin’s cyst?

The symptoms of a Bartholin’s cyst depend on its size. Small cysts may not be noticeable. If the cyst grows, you may feel a lump near your vaginal opening. When cysts are infected, they can be tender, and it can become painful to sit or have sex. Infected cysts can also cause you to be feverish and feel under the weather.

How is a Bartholin’s cyst diagnosed?

Bartholin’s cysts and abscesses have characteristic appearances and can usually be diagnosed after a consultation and examination with your GP. Often, a sample of secretions from your vagina or cervix is also taken to test for possible infections. If you are over 40 or postmenopausal, your doctor may also recommend a sample of the lump (biopsy) is done to check for cancerous cells. This is a small procedure, and it is normally done by specialists in the hospital.

What is the treatment for a Bartholin’s cyst?

A small cyst that does not cause symptoms may well resolve by itself and often does not need treatment. You might not even realise you ever had it.

If you find a lump, however, you need to report that to your doctor. Lumps around your vagina are not normal, and your doctor will be able to confirm the reason for the lump, exclude other causes and begin the appropriate treatments.

Treatment can be as simple as taking NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen to reduce swelling and pain. Hot baths can help ease open the blocked glands and relieve symptoms.

If the cyst is large or becomes infected, it will probably need treatment, not least because it can be very painful. Antibiotics can help, especially in the early stages. If the infection goes untreated and an abscess forms, however, a small procedure called marsupialisation might need to be done by a gynaecologist in the hospital. This procedure will both drain the pus in the abscess and create a new opening to prevent future blockages. Usually, this can be done under a local anaesthetic, which just numbs the area around the Bartholin’s gland. For large cysts, the procedure might need to be done under general anaesthetic.

After these procedures, you will likely be encouraged to take warm baths, as you would with smaller, more easily treated Bartholin’s cysts. This is to help keep the area clean, ease discomfort and to continue to promote drainage of the cyst.

Will the cyst come back?

Normally, no. These vast majority of these cysts tend to be one-time things. And for cysts that persist or recur several times, you can repeat effective treatments or find an alternative form of management. If these don’t work, your doctor may recommend that you undergo a larger operation to remove the Bartholin’s gland altogether.

Jenny’s story

Jenny is 40 years old and juggles a career with being a mum of three teenagers.

“One morning in the shower I noticed a lump down below. I knew I should get it checked by the doctor but struggled to find the time to make an appointment. The days passed, and the lump seemed to be getting bigger. When it started to become painful, I decided to see the GP. They asked me about my concerns and examined my vagina. At the end of the appointment, I was given a script for some antibiotics and offered a referral for a biopsy at the local hospital. The GP explained that she thought the lump was a Batholin’s cyst; however, a sample should be taken to rule out it being a cancer. The days waiting for the biopsy result dragged by. After a week the GP called with some good news. The lump was a Batholin’s cyst. The antibiotics have thankfully worked, and the lump has almost disappeared. My GP suggested a follow-up appointment in several weeks to check the lump has completely resolved, which fortunately it did.”

Useful links

NHS – Bartholin’s Cyst https://www.nhs.uk/conditions/bartholins-cyst/

Patient Info https://patient.info/womens-health/vulval-problems-leaflet/bartholins-cyst-and-abscess

Vulval cancer, Cancer Research UK https://www.cancerresearchuk.org/about-cancer/vulval-cancer/about