Bartholin's cyst
| Bartholin's cyst | |
|---|---|
| Classification and external resources | |
 Bartholin's cyst of the right side | |
| ICD-10 | N75.0 |
| ICD-9 | 616.2 |
A Bartholin's cyst is formed when a Bartholin's gland is blocked, causing a fluid-filled cyst to develop. A Bartholin's cyst is not an infection, although it can be caused by an infection, inflammation, or physical blockage (mucus or other impediment) to the Bartholin's ducts (tubes which lead from the glands to the vulva). If infection sets in, the result is a Bartholin's abscess. If the infection is severe or repeated, a surgical procedure known as marsupialization may be required to stop further recurrences.
Bartholin's cysts are most likely to occur in women of child-bearing age. When they occur in women over 40, sometimes the doctor will recommend a biopsy just to be sure there are no cancer cells present, even though cancer of the Bartholin's gland is extremely rare.
A Bartholin's cyst can grow from the size of a pea to the size of an egg. Cysts are not sexually transmitted. There is no known reason for their development and infection is rare. However, even with an abscess, a bacterial infection or STD is not the cause.
Epidemiology
The incidence of Bartholin duct cysts is 0.55 per 1000 person-years and the incidence in women aged 35–50 years is 1.21 per 1000 person-years.[1] The incidence of Bartholin duct cysts increase with age until menopause, decreasing thereafter.[1] Two percent of women will have a Bartholin's gland cyst at some point in their lives.[2] White and black women may be less often affected than Hispanic women.[2] The risk of developing a Bartholin's gland cyst increases with the number of childbirths.[2]
Pathophysiology
In order for a Bartholin's gland cyst to develop, the duct that drains the cyst must become blocked.[3] This blockage may occur due to an infection or a mucus plug.[3] The secretions from the Bartholin's gland are retained, and a cyst forms.[2]
Signs and symptoms
Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[2] or sexual intercourse (dyspareunia).[3] They are usually between 1 and 4 cm, and are located just medial to the labia minora. Most Bartholin's cysts only affect the left or the right side (unilateral). If the cyst is small usually there is no pain involved. If the cyst becomes very large, it can cause significant pain.
Treatment
Often, no treatment is necessary, since Bartholin's cysts are often asymptomatic. Small, asymptomatic cysts simply be observed over time to see if they grow. For cases where intervention is necessary, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, for the achievement of absence of swelling and discomfort and the appearance of a freely draining duct.[4]
Catheterization is a minor procedure and can be performed in an office setting by a physician. A small tube (a catheter) is inserted into the cyst[2] and inflated to keep it in place. The catheter stays in place for 2 to 4 weeks, draining the fluid and causing a normal gland opening to form, after which the catheter is removed. The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.
Cysts may also be opened permanently, a method called marsupialization,[5] in which an opening to the gland is formed with stitches which hold the secretion channel open.
If the cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Nonprescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort. Warm compresses can speed healing. Disposable chemical heating pads, such as those used inside gloves to keep hands warm, can be worn inside clothing and last for several hours, providing long-lasting relief.
If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.
Prognosis
While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming; however, surgical or laser removal of a cyst makes it less likely that a new one will form at the same site. However, those with a cyst are more likely than someone else to get one in the future. They can recur every few years or more frequently. Many women who have marsupialization done find that the recurrences may slow, but do not actually stop.
References
- ↑ 1.0 1.1 Yuk, JS; Kim, YJ; Hur, JY; Shin, JH (2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 122 (1): 62–4. doi:10.1016/j.ijgo.2013.02.014. PMID 23618035.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Omole, F; Simmons, BJ; Hacker, Y (Jul 1, 2003). "Management of Bartholin's duct cyst and gland abscess". American family physician 68 (1): 135–40. PMID 12887119.
- ↑ 3.0 3.1 3.2 Eilber, Karyn Schlunt; Raz, Shlomo (September 2003). "Benign Cystic Lesions of the Vagina: A Literature Review". The Journal of Urology 170 (3): 717–722. doi:10.1097/01.ju.0000062543.99821.a2. PMID 12913681.
- ↑ Bartholin's cyst from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013
- ↑ Haider Z, Condous G, Kirk E, Mukri F, Bourne T (April 2007). "The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study". Aust N Z J Obstet Gynaecol 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID 17355304.
External links
- GP Notebook <<<< broken link
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