Bartholin’s Gland Cyst

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PATHOPHYSIOLOGY

Obstruction of the distal Bartholin’s duct may result in the retention of secretions, with resultant dilation of the duct and formation of a cyst. The cyst may become infected, and an abscess may develop in the gland. A Bartholin’s duct cyst does not necessarily have to be present before a gland abscess develops.

Bartholin’s gland abscesses are polymicrobial. Although Neissearia gonorrhea is the predominant aerobic isolate, anaerobes are the most common pathogens. Chlamydia trachomatis also may be a causative organism. However, Bartholin’s duct cyst and gland are no longer considered to be exclusively the result of sexually transmitted infections. Vulvovaginal surgery is an uncommon cause of these cyst and abscesses.

LABORATORY EXAMINATION

• gynecological pelvic exam
• a culture is often performed
• excisional biopsy

MEDICAL MANAGEMENT

The treatment of a Bartholin’s duct cyst depends on the patient’s symptoms which may vary depending on the severity of symptoms and may include home treatment.

If the cyst is not infected, treatment options include:

• soaking of the genital area with warm towel compress
• soaking of the genital in a sitz bath
• use of non-prescription pain medication to relieve mild discomfort

If the cyst is infected, there are several treatments available to treat abscess, including:

• soaking of the genital in a sitz bath
• treatment with antibiotics
• use of prescription or non-prescription pain medication
• incision and drainage
• placement of a drain (Word Catheter)
• marsupialization
• window operation
• use of a carbon dioxide laser
• incision and drainage followed by treatment with silver nitrate
• removal of the entire Bartholin’s duct cyst

A Word catheter is commonly used to treat Bartholin’s duct cysts and gland abscesses. The stem of this rubber catheter is 1 inch long and the diameter of a no. 10 French Foley catheter. The small, inflatable balloon tip of the Word catheter can hold about 3 mL of saline. After sterile preparation and the administration of a local anesthetic, the wall of the cyst or abscess is grasped with a small forceps, and a no. 11 blade is used to make a 5-mm (stab) incision into the cyst or abscess. It is important to grasp the cyst wall before the incision is made; otherwise the cyst can collapse, and a false tract may be created. The incision should be within the introitus external to the hymenal ring in the area of the duct orifice. If the incision is too large, the Word catheter will fall out. Sterile gloves Iodine solution Lidocaine (Xylocaine), 1% or 2% solution 30-gauge, 1-inch needle with 5-mL syringe for injecting lidocaine Word catheter Saline solution, 3 mL Luer Lock 3-mL syringe for inflating balloon with saline solution Small forceps for grasping cyst wall No. 11 scalpel Gauze pads, 4 3 4 inch Hemostats to break up loculations After the incision is made, the Word catheter is inserted, and the balloon tip is inflated with 2 to 3 mL of saline solution injected through the hub of the catheter. The inflated balloon allows the catheter to remain within the cavity of the cyst or abscess. The free end of the catheter can be placed in the vagina. To allow epithelialization of the surgically created tract, the Word catheter is left in place for four to six weeks, although epithelialization may occur as soon as three to four weeks. Sitz baths taken two to three times daily may aid patient comfort and healing during the immediate postoperative period. Coitus may be resumed after catheter insertion. Unless there is evidence of cellulitis, antibiotic therapy is unnecessary. If cellulitis is present, cultures may be obtained, but the results rarely change management. Empiric broad-spectrum antibiotic therapy is started before culture results are available. If a Bartholin’s cyst or abscess is too deep, Word catheter placement is impractical, and other options must be considered.

An alternative to Word catheter placement is marsupialization of a Bartholin’s cyst. This procedure should not be used when an abscess is present. Marsupialization can be performed in the office or, if the cyst is deeply seated, in an outpatient surgical suite. After sterile preparation and the administration of a local anesthetic, the cyst wall is grasped with two small hemostats. A vertical incision is made in the vestibule over the center of the cyst and outside the hymenal ring. The incision should be about 1.5 to 3 cm long, depending on the size of the cyst. 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 2-0 absorbable suture. Daily sitz baths should begin on the first postoperative day. Approximately 5 to 15 percent of Bartholin’s duct cysts recur after marsupialization. Complications associated with the procedure include dyspareunia, hematoma, and infection.

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