Bartholin cysts and abscesses: What are they, and how are they treated?

Leading women's health expert and consultant gynaecologist Mr Manhantesh Karoshi provides an expert insight to Bartholin cysts, or Bartholin abscesses, in this informative article. 

What’s a Bartholin cyst?

It’s a type of vaginal cyst. It forms on the labia, or vaginal lips, near the opening of the vagina.

Bartholin glands are small glands that produce fluid for vaginal lubrication. A cyst occurs when one of gland ducts becomes blocked. This causes mucus build up and a lump begins to form on the labia. It usually occurs on only one side. Some cysts are small and painless. However, others may become infected and be painful.

The Bartholin glands are important organs of the female reproductive system. Danish anatomist Caspar Bartholin Secundus first wrote about them in 1677.  Their primary function is to produce a mucoid secretion which aids vaginal and vulvar lubrication.

What does a cyst look like?

A Bartholin cyst appears as a round bump under the labia skin. They’re often painless but can become red, tender, and swollen if they’re infected. Some may look like they’re filled with pus or fluid, and can vary in size, ranging from as small as a pea to as large as a golf ball. One side of the labia appear larger or uneven.

Who develops Bartholin cysts?

These cysts can develop in about two per cent of women. They’re more common in those of reproductive age and are less common after menopause.

What are the causes of a Bartholin cyst?

The exact cause of these cysts is unknown. Some include:

• Injury, irritation or excess skin growth in the vaginal area;
• Sexually transmitted infections (STIs) like chlamydia or gonorrhoea.
• Bacterial infections, for example Escherichia coli (E. coli).

What are the symptoms of a Bartholin cyst?

Many Bartholin cysts are small and are symptomless, other than minor irritation. However, if the cyst is infected, symptoms can include:

• Discomfort and pain during sex, walking, sitting, or inserting a tampon;
• Swelling and tenderness;
• Fever or chills;
• Redness;
• Drainage;
• Cyst growth.

Are the cysts contagious?

If a cyst is caused by an STI, the infection itself can be passed on. Most Bartholin cysts don’t become infected, however, Also, they can’t spread through skin-to-skin contact.

Are these cysts caused by an infection?

Bacterial infections such as E. coli or STIs including gonorrhoea and chlamydia, can cause Bartholin cysts. They can block the Bartholin gland and lead to cyst formation.

How is a Bartholin cyst diagnosed?

A Bartholin cyst can be diagnosed via physical examination. A professional will assess the cyst’s size and look for signs of infection. If discharge is produced, fluid may be tested for STIs or other bacterial infections. A biopsy may be performed in order to rule out cancer in older women.

What are the treatments for a Bartholin cyst?

Bartholin cyst treatment depends on symptoms. If the cyst is small, painless, and isn’t infected, it may not require treatment.

However, if symptoms persist or there’s growth, it may indicate an abscess (infection) that needs to be addressed.

Treatment can include:

• Sitz baths: Sitting in warm water a few times a day can provide comfort and promote healing. It may help an infected cyst that has burst and drain on its own.
• Over-the-counter pain medications: Pain relievers can help with discomfort.
• Antibiotics: They may be prescribed if the cyst becomes infected or tests reveal an STI.
• Surgical draining: In large and infected cysts, surgery may be necessary to drain the fluid. A catheter called a Word Catheter may be inserted for drainage.
• Marsupialisation: This is a surgical procedure that involves opening and draining the cyst. The cyst wall’s edges are then stitched to create a permanent pocket in order to achieve continuous drainage. This approach is useful for recurring Bartholin cysts.
• Removal of the Bartholin gland: In extremely rare cases where other treatments are ineffective, the Bartholin glands may be surgically removed.
• It’s important to consult with a healthcare provider in order to get proper guidance on treatment. An attempt to drain or squeeze a cyst at home can lead to infection. Plus, it can worsen symptoms.

How do I manage Bartholin cyst symptoms?

You can try at-home remedies such as:

• soaking in a warm bath several times a day (sitz baths) and taking over-the-counter pain relievers.

These measures can help alleviate discomfort. Many Bartholin cysts resolve by themselves without medical treatment. However, it’s advisable to speak to your doctor if the cyst becomes painful or infected.

Do Bartholin cysts go away on their own?

Most Bartholin cysts resolve on their own. As previously mentioned, Sitz baths are often recommended. This is to manage symptoms.

If a cyst drains or bursts by itself, it’s generally considered normal. Keeping the area clean and dry can help to prevent spread of infection. It’s important not to squeeze or drain a Bartholin cyst yourself, as this can cause infection.

If the cyst becomes painful, infected, or persists for several weeks without improvement, it’s recommended to contact a healthcare provider.

How long does a Bartholin cyst last?

The length of a Bartholin cyst varies. This depends on size and whether it has become infected. Typically, cysts completely resolve within a few weeks. After examination, a health professional can give an estimate of how long symptoms may last.

What can come out of a Bartholin cyst?

When a Bartholin cyst opens, it may release substances such as:

• pus;
• mucus;
• bacteria;
• blood, or other fluids.

The discharge can be thick and ranges from light yellow to brown or red. Bartholin cysts that are infected may have an unpleasant odour when they rupture. It’s important to keep the affected area clean and practice good hygiene.

Should I pop a Bartholin cyst?

It isn’t ever recommended to squeeze, pop, or insert sharp objects into a Bartholin cyst in order to force it to open. This is because it can cause injury and spread infection.

It’s normal for a Bartholin cyst to drain on its own after several days of treatment, such as sitz baths or antibiotics.

Prevention

In most cases, Bartholin cysts can’t be prevented. This is because the exact cause is unknown.

However, by maintaining good hygiene practices and using condoms during sex to lower the risk of STIs, the risk of complications from infections can be reduced.

Can a Bartholin cyst keep coming back?

Recurring Bartholin cysts can occur. However, doctors are unsure why this happens. They’re usually treatable, but recurring cysts may require more intensive treatment.

Concerned about a Bartholin cyst, or other gynaecological condition, arrange a consultation with Mr Karoshi via his Top Doctors profile.