What are the Bartholin Glands?
The Bartholin glands are a pair of pea sized glands located on either side of the vaginal opening, just on the inside of the inner lips of the vulva (labia minora) (see image below). In a normal situation, they cannot be felt easily but have an important function of lubricating the vagina, keeping it moist during sex.
The fluid flows into the vagina through little ducts that lead from the glands during sexual arousal. If the mouth of one of these ducts gets blocked, the duct gets backed up with fluid forming a Bartholin’s cyst.
When do cysts occur?
These cysts are almost always on one side and affect sexually active women typically between the ages of 20 to 30 years of age. This may be felt as a small painless lump at the entrance of the vagina by the woman herself or if she is seeing a health professional for a pelvic examination. She may notice some discomfort when having sex or the cyst may start to feel tender on touch.
The cyst may grow to a reasonable size (golf ball) but may remain relatively painless so the woman may not notice until the cyst gets infected, when the inflamed cyst with pus inside of it that cannot drain easily becomes very painful and uncomfortable. This is now known as a Bartholin’s abscess.
A Bartholin’s cyst or abscess is rather common. Prevention is not possible but good sexual hygiene should always be encouraged. Partners should have a STI screen before becoming intimate and the use of condom barrier protection helps reduce the risk of sexually transmitted infections (STI).
Treatment of Bartholin’s cysts
Treatment depends on the woman’s wishes, the size of the cyst, how painful the cyst is and whether the cyst is infected. Sometimes, the cyst drains on its own, especially if soaking the area in warm water several times a day along with painkillers that the woman normally takes. In this situation, the woman can be reassured with no further need for treatment.
Antibiotics
If the cyst is picked up in the very early stages of infection, a short course of antibiotics prescribed by your doctor may be all that is needed to settle the cyst.
Surgical Drainage
In other situations, where the cyst has become an abscess, surgical drainage is needed, with or without antibiotics. This can occur very rapidly, needing the woman to seek urgent medical treatment. This is because she finds it extremely painful to sit or walk or may start to feel unwell with a fever.
Bacteria from the back passage, like E Coli or a STI like chlamydia or gonorrhoea, may be the cause of the infection, so it is important to have swabs taken to rule out these infections as they need treatment.
Surgery
The commonest surgical treatment to a Bartholin’s cyst or abscess is laying the duct of the Bartholin’s gland open (marsupialisation). This may be performed as an outpatient procedure under local anaesthetic or for larger cysts, as a day case procedure under a short general anaesthetic. With a larger abscess, a temporary drain or packing gauze may be placed inside the healing cyst. You may notice a few stitches that will dissolve in a few weeks. Any fluid, pus or tissue that is obtained at surgery is sent for analysis to ensure the right treatment is offered.
Conservative Treatment
If women wish to avoid an anaesthetic or if they are pregnant, there is a conservative option using a small latex balloon (Word Catheter) that is inserted into the cyst or abscess under local anaesthetic and secured to encourage drainage. It allows the duct to re-epithelialise so there is continued future drainage through a tract. Antibiotics may be prescribed. The little tube is removed in a few days once it stops draining fluid. It can sometimes fall out on its own as the cyst or abscess reduces in size.
Healing after treatment can take a few days to a few weeks. Stay on top of pain with over the counter painkillers.
A Bartholin’s cyst or abscess may recur and require treatment, with either of the above options.
If you notice any vaginal lumps that you are not sure about, especially after the age of 50, you should always seek medical advice so diagnosis can be confirmed, and rare but more serious conditions such as vulval or Bartholin gland cancer is ruled out.
Dr Nitu Bajekal FRCOG Dip IBLM
Consultant Gynaecologist and Women’s Health Expert
Lifestyle Medicine Physician
Updated January 2020
