The Bartholin glands

The Bartholin glands

Definition

The Bartholin glands are located at either side of the opening of the vagina.

When these glands are normal it can’t be seen or felt. These glands produce fluid which can act as lubrication of the vagina. Sometimes the fluids from the Bartholin glands get blocked and causes swelling called Bartholin cyst. If the fluid in the cyst is infected then it leads to the collection of pus surrounded by an inflamed tissue (Bartholin abscess).  If the cyst grows very larger, it will cause pain in the surrounding skin when you walk, sit down or sex. The cyst can sometimes affect the outer pair of labia.

Bartholin Cyst

Anatomy of Bartholin glands

Epidemiology

Two percent of women will have a Bartholin’s gland cyst at some point in their lives. They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years. The incidence of Bartholin duct cysts increases with age until menopause and decreases thereafter. Hispanic women may be more often affected than white women and black women. The risk of developing a Bartholin’s gland cyst increases with the number of childbirths.

Risk factors

• If the cyst is untreated, then it can be more serious and spread to other parts of the body.
• Women who are of childbearing age will have higher risk
• Unprotected sex
• Usually, occur in women who are nulliparous or of low parity

 Causes

• Bartholin cyst is caused due to the block in the Bartholin glands. The fluid produced from the gland accumulates causes swelling and form cyst. Then cyst is infected and form abscess.
• The infection is caused by bacteria’s such as Chlamydia trachomatis (Chlamydia) andGonococcus (Gonorrhoea) through sexual intercourse. And also bacteria from intestinal tract such as Escherichia coli. It is the common causes for Bartholin cysts.

Symptoms

If the cyst is small you may not have any symptoms. But large cysts or infected cyst can cause symptoms. Symptoms will vary based on the size and condition of the cyst.

Symptoms of non-infected cyst:

• Redness or swelling in the vulva area
• Discomfort when you sit, walk or have sex
• Painless lump in the vulva area

Symptoms of infected cysts:

• Pus from the cyst
• Chills and fever

• Pain in the vulva area that makes you be discomfort while walking, sitting and during sex

• Swelling in the opening of vagina

Complications

Some of the complications that include:

• Continuous and occurrence of the cyst
• Recurrence of the cyst that needs frequent treatment
• Damage to the nerves, muscles, and blood vessels during surgery
• Infection after the surgery at the wound site is a potential complication

Diagnosis and test

• Questions about your medical history
• To diagnose Bartholin cyst, first, your doctor will do physical examination to check for any lumps in the opening of vagina that would indicate the sign of abscess or cyst
• Doctor may take sample of secretions from your vagina or cervix to check for sexually transmitted infections such as syphilis, gonorrhea or genital warts, these may also exist with Bartholin cyst abscess
• If you are above 40 age, your doctor may do biopsy to check for cancerous cells

Treatment and medications

Usually, small cyst doesn’t require treatment, it can resolve by itself. But Bartholin abscess needs treatment as it can be very painful. The main aim of the treatment is to remove the pus from the cyst or abscess and to make opening or duct to prevent blockage in the glands.

There are different ways of treatment are available. Based on the severity and condition treatment will vary.

• Antibiotic treatment
• Word Catheter
• Marsupialisation
• Incision and Drainage

Antibiotic treatment: It is required when you have small abscess smaller than 3cm. you may be offered a course of antibiotics. This has a good chance of curing abscess. In a large abscess, if the pus is drained out, you may not need antibiotics.

Word catheter: In this technique word catheter has been used. It is thin rubber tube which is 3cm long with the balloon at one end. The catheter is inserted with a local anesthetic. To make the procedure comfortable, the numbing cream is applied in the area abscess area. A small cut is made in the cyst or abscess and the pus is drained. Then the catheter head is inserted into the cyst and the balloon is inflated to keep the catheter in place for 2 to 3 weeks.

Word catheter

Placement of Word catheter in a patient with a Bartholin gland cyst

The main aim of this treatment is to stop the closing of the gland’s opening, So that the new duct can form through the catheter. This helps to allow the normal gland secretion, which can help to prevent Bartholin abscess in future.

Marsupialisation: This is the procedure where done under local or general anesthetic. It involves making a small cut in the cyst or abscess, draining the fluid or pus from the cyst and then placing some dissolvable stitches so that permanent opening is made. Through this opening, a catheter is placed for few days so that the fluid or pus which are left will drain freely and doesn’t occur again.

A) Marsupialization technique in the treatment of Bartholin gland cyst

B) Delayed-absorbable sutures on a small needle

Incision and Drainage: It can also be used to treat other types of cyst by making a small cut in the cyst or abscess and letting pus to drain. For e.g. hair follicle cyst or abscess. But this technique is not recommended for Bartholin cyst abscess, it will not help the gland to be in open. Again this may lead to abscess or cyst in future.

Prevention

• There is no way to prevent Bartholin cyst. But some practices can help to have a good hygienic condition that keeps bacteria out of the area, which can help to prevent abscess cyst. The practices such as safe sex and condom use

• Always maintaining a good hygiene health habits may help to prevent cyst infection and the formation of abscess
• Should drink plenty of water and other fluid such as fruit juices
• If you’re in long bike travel or horse rides, make sure that your genital area is protected with soft padding or cushioning
• Don’t use virginal sprays, deodorants or douches
• Wear loose-fitting clothes and cotton underwear’s