After sterile preparation and the administration of a local anesthetic, the cyst wall is grasped with two small hemostats 2 , 16 Table 4. A vertical incision is made in the vestibule over the center of the cyst and outside the hymenal ring. After the cyst is vertically excised, the cavity drains spontaneously. The cavity also may be irrigated with saline solution and, if necessary, loculations can be broken up with a hemostat. The cyst wall is then everted and approximated to the edge of the vestibular mucosa with interrupted absorbable suture.
Approximately 5 to 15 percent of Bartholin's duct cysts recur after marsupialization. Although Bartholin's gland abscesses may rupture and drain spontaneously, recurrence is likely, and surgical excision may be necessary.
Excision is not an office-based procedure. Cultures for N. However, Bartholin's gland abscesses tend to be polymicrobial, and empiric broad-spectrum antibiotic therapy should be used. Excision of the Bartholin's gland should be considered in patients who do not respond to conservative attempts to create a drainage tract, but the procedure should be performed when there is no active infection.
Some investigators 2 , 10 recommend excision of the Bartholin's gland to exclude adenocarcinoma when cysts or abscesses occur in patients more than 40 years of age.
Even though adenocarcinoma of the Bartholin's gland is rare, gynecologic oncology referral should be considered for older patients with Bartholin's duct cysts or gland abscesses. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Omole completed a family medicine residency at Morehouse School of Medicine.
Hacker graduated from the University of the West Indies, Jamaica, and completed a family medicine residency at Morehouse School of Medicine. Address correspondence to Folashade Omole, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest.
Sources of funding: none reported. The authors thank Barbara S. Apgar, M. Stenchever MA. Comprehensive gynecology. Louis: Mosby, —6,—6. Office management of Bartholin gland cysts and abscesses. Am Fam Physician. Gynaecology illustrated. Azzan BB. Bartholin's cyst and abscess. A review of treatment of 53 cases.
Br J Clin Pract. A practical, inexpensive office management of Bartholin's cyst and abscess. Nebr Med J. Kaufman RH. Benign diseases of the vulva and vagina. St Louis: Mosby, — Bartholin's duct abscess and cyst: a case-control study. South Med J. The vulva. Kistner's Gynecology: principles and practice. Louis: Mosby, —8. Postmenopausal Bartholin gland enlargement: a hospital-based cancer risk assessment.
Obstet Gynecol. Atlas of vulvar disease. Cheetham DR. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Smith RP. Bartholin gland: Cysts. In: Netter's Obstetrics and Gynecology.
Elsevier; Accessed Feb. Bartholin cyst. Mayo Clinic; Illingworth BJG, et al. Evaluation of treatments for Bartholin's cyst or abscess: A systematic review. British Journal of Obstetrics and Gynaecology. Chen KT.
The result is a cyst. Cysts may become infected, forming an abscess. As women age, they are less likely to have cysts and abscesses. Typically, what causes the blockage is unknown.
Rarely, cysts result from a sexually transmitted disease Overview of Sexually Transmitted Diseases STDs Sexually transmitted venereal diseases are infections that are typically, but not exclusively, passed from person to person through sexual contact.
Sexually transmitted diseases may be caused The small glands on either side of the vaginal opening, called Bartholin glands, may become blocked. Fluids then accumulate, and the gland swells, forming a cyst. Cysts range from the size of a pea to that of a golf ball or larger. Most often, they occur only on one side. They may become infected, forming an abscess. Most Bartholin cysts do not cause any symptoms. But if cysts become large, they can cause discomfort during sitting, walking, or sexual intercourse.
Women may notice a painless lump near the opening of the vagina, making the vulva look lopsided. If the cyst becomes infected forming an abscess , it cause severe pain and sometimes fever. Abscesses are tender to the touch. The skin over them appears red, and women may have a discharge from the vagina. The cyst continues to enlarge or persists after several days of immersing the area in hot water in a tub or sitz bath. If a cyst is large enough for a woman to notice it or for symptoms to develop, doctors can see or feel the cyst during a pelvic examination Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to Doctors can usually tell whether it is infected by its appearance.
If you do not have any noticeable symptoms, it's unlikely you'll need treatment. If the cyst is painful, a GP may recommend some simple self care measures, such as soaking the cyst in warm water several times a day for 3 or 4 days and taking painkillers you can buy from a pharmacy or shop. If these do not work, several treatments are available to treat the pain and any infection. If necessary, the cyst can be drained. Most of these treatments involve a minor surgical procedure.
A Bartholin's cyst usually affects sexually active women aged between 20 and Bartholin's cysts do not usually affect children because the Bartholin's glands do not start functioning until puberty. The cysts are also uncommon after the menopause as this usually causes the Bartholin's glands to shrink. It's not clear exactly why Bartholin's cysts develop, so it's not usually possible to prevent them. But as some are thought to be linked to STIs, practising safe sex using a condom every time you have sex can help reduce your chances of one developing.
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