Bartholin’s Gland Cyst

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Diseases of the vulva in collective comprise only a small portion of gynecologic practice. Several are inflammatory dermatologic diseases that affect hair-bearing skin elsewhere on the body may also arise on the vulva, so that vulvitis may be encountered in psoriasis, eczema, and allergic dermatitis. The vulva is also prone to skin infections, because it is frequently exposed to secretions and moisture. Nonspecific vulvitis is particularly likely to occur in the blood dyscrasias, uremia, diabetes mellitus, malnutrition, and the avitaminoses. Most skin cyst and tumors can also come about in the vulva. In this case study, Bartholin’s duct cyst is discussed.

Obstruction of the main duct of Bartholin’s gland results in retention of secretions and cystic dilatation. These glands are found in the vulva within the skin folds that cover the vaginal opening. More than one cyst may be present. Bartholin’s duct cyst may range in size from a small marble to a golf ball size, and they grow slowly. When cyst become infected, the contents become purulent. If the infection goes untreated, a Bartholinian abscess can result. The obstruction which causes cyst and abscess formation most commonly follows a bacterial, chlamydial or gonococcal infection.

Bartholin’s gland cyst, the most common cystic growths in the vulva, occurs in the labia majora. Two percent of women develop a Bartholin’s gland cyst or abscess at some time in life. Abscesses are almost three times more common than cysts. Gradual involution of the Bartholin’s glands can occur by the time a woman reaches 30 years of age. This may account for the more frequent occurrence of Bartholin’s duct cysts and gland abscesses during the reproductive years, especially between 20 and 29 years of age.

PREDISPOSING FACTORS

Bartholin’s duct cyst form when the glands become blocked and swell with fluid for any reason, such as infection, injury or chronic inflammation. The cyst can be in the gland or in the tube draining in the gland. These cyst are not usually infected, do not usually cause pain and may go away without treatment. Most women do not need medical treatment. It is extremely rare for a Bartholin’s duct cyst to become cancerous. Bartholin gland tumors are usually found in women age 40 or older. Bartholin’s duct cyst are not usually caused by or related to sexually transmitted diseases.

SYMPTOMS

Symptoms of an uninfected Bartholin’s duct cyst include the following:

• painless lump on one side of the vulva area
• redness or swelling in the vulva area

Symptoms of an abscessed Bartholin’s duct cyst include the following:

• pain that occurs with walking, sitting, physical activity
• dyspareunia
• fever and chills
• increased swelling in the vulva area over a 2 to 4 day period
• drainage from the cyst, normally occurring 4 to 5 days after the swelling starts

ANATOMY & PHYSIOLOGY

Bartholin’s gland or the greater vestibular glands are homologues of the Cowper’s glands in males. These glands develop from buds in the epithelium of the posterior area of the vestibule. It location is bilaterally at the base of the labia minora and drain through 2 to 2.5cm long ducts that empty into the vestibule at about the 4 o’clock and 8 o’clock positions. The glands are usually the size of a pea abd rarely exceed 1cm. They are not palpable except in the presence of disease or infection. These glands secrete alkaline mucus which helps to keep the vaginal introitus lubricated and enhance sperm survival.

Figure 1. Location of Bartholin’s Gland

If a Bartholin’s duct cyst remains  small and does not become inflamed, it may be asymptomatic. However, the cyst typically presents as a medially protruding mass in the posterior introitus in the region where the duct opens into the vestibule. If the cyst becomes infected, an abscess may form in the gland. Induration usually is present around the gland, and walking, sitting, or sexual intercourse may result in vulvar pain.

Bartholin’s duct cysts and gland abscesses must be differentiated from other vulvar masses. Because the Bartholin’s gland usually shrink during menopause, a vulvar growth in a postmenopausal woman should be evaluated for malignancy, especially if the mass is irregular, nodular, and persistently indurated.

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