A Bartholin’s cyst is a fluid-filled sac within one of the Bartholin’s glands of the vagina

Aetiology

• A build-up of mucus secretions can cause the duct of the gland to become blocked, from which a cyst can develop
• The cyst itself can become infected, and if untreated, develop into an abscess
• The infective organisms are usually aerobic, with Escherichia coli, MRSA and STIs being the most common

Clinical features

Symptoms

• Small Bartholin’s cysts are often asymptomatic
• If cysts become large, they can cause vulvar pain (particularly when walking and sitting), and superficial dyspareunia
• Bartholin’s abscesses typically present with acute onset of pain, and/or difficulty passing urine

Signs

• On examination, a unilateral labial mass will be observed, typically from the posterior aspect of the labia majora

Investigations

• Often clinical diagnosis
• Consider biopsy if women is over 40 to exclude vulval carcinoma

Management

• If the cyst is small and asymptomatic, no treatment is required
• Treatment is usually by:
  • Word catheter
  • Marsupialisation
• Antibiotics not generally used but can be considered if patient is systemically unwell or immunocompromised