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'{{Infobox medical condition (new) | name = Bartholin's cyst | synonyms = Bartholinitis, Bartholin's duct cyst, Bartholin's abscess | image = https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Ftse3.mm.bing.net%2Fth%3Fid%3DOIP.wUvbhthM3WpHUQIwTHGYgAHaFH%26pid%3DApi&f=1 | caption = Bartholin's cyst of the right side | pronounce = | field = [[Gynecology]] | symptoms = Swelling of one side of the vagina, pain<ref name=Mer2018Pro/> | complications = [[Abscess]]<ref name=Omole2003/> | onset = Childbearing age<ref name=Omole2003/> | duration = | types = | causes = Typically unknown<ref name=Mer2018Pro/> | risks = | diagnosis = Based on symptoms and examination<ref name=Mer2018Pro/> | differential = [[Sebaceous cyst]], [[hernia]], [[hidradenitis suppurativa]], [[folliculitis]], [[vulvar cancer]]<ref name=Lee2015/><ref name=Fer2018/> | prevention = | treatment = Placement of a Word catheter, [[incision and drainage]], [[marsupialization]], [[sitz baths]]<ref name=Lee2015/><ref name=Mer2018Pro/> | medication = | prognosis = | frequency = 2% of women<ref name=Omole2003/> | deaths = }} <!-- Definition and symptoms --> A '''Bartholin's cyst''' occurs when [[Bartholin's gland]], within the [[labia]], becomes blocked.<ref name=Mer2018Pro>{{cite web |title=Bartholin Gland Cysts |url=https://www.merckmanuals.com/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/bartholin-gland-cysts |website=Merck Manuals Professional Edition |accessdate=12 September 2018}}</ref> Small cysts may result in few symptoms.<ref name=Mer2018Pro/> Large cysts may result in swelling of one side of the vagina, and [[pain with sex]] or walking.<ref name=Mer2018Pro/> If the cyst becomes infected an [[abscess]] occurs.<ref name=Omole2003>{{cite journal |last1=Omole |first1=Folashade |last2=Simmons |first2=Barbara J. |last3=Hacker Yolanda |title=Management of Bartholin's duct cyst and gland abscess |journal=American Family Physician |volume=68 |issue=1 |pages=135–40 |year=2003 |pmid=12887119 |url=http://www.aafp.org/link_out?pmid=12887119 }}</ref> These are typically red and very painful.<ref name=Omole2003/> <!-- Cause --> The cause is typically unknown.<ref name=Mer2018Pro/> With an abscess, a bacterial infection has occurred, but it is not usually a [[sexually transmitted infection]] (STI).<ref name=Rosen2014Chp137>{{cite book|last=Marx|first=John A. Marx|title=Rosen's emergency medicine : concepts and clinical practice|date=2014|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=1455706051|pages=Chapter 137|edition=8th|chapter=Skin and Soft Tissue Infections}}</ref> Rarely [[gonorrhea]] may be involved.<ref name=Mer2018Pro/><ref name=Fer2018>{{cite book |last1=Ferri |first1=Fred |title=Ferri's clinical advisor 2018 : 5 books in 1 |date=2017 |publisher=Elsevier Canada |isbn=978-0323280495 |page=175}}</ref> Diagnosis is typically based on symptoms and [[physical examination|examination]].<ref name=Mer2018Pro/> In those over the age of 40, a [[tissue biopsy]] is recommended to rule out [[cancer]].<ref name=Lee2015>{{cite journal|last1=Lee|first1=MY|last2=Dalpiaz|first2=A|last3=Schwamb|first3=R|last4=Miao|first4=Y|last5=Waltzer|first5=W|last6=Khan|first6=A|title=Clinical Pathology of Bartholin's Glands: A Review of the Literature.|journal=Current Urology|date=May 2015|volume=8|issue=1|pages=22–5|doi=10.1159/000365683|pmid=26195958|pmc=4483306}}</ref><ref name=Mer2018Pro/> <!-- Treatment --> If there are no symptoms, no treatment is typically needed.<ref name=Omole2003/><ref name=Mer2018Pro/> In those with symptoms, drainage is recommended.<ref name=Omole2003/> The preferred method is the insertion of a [[Word catheter]] for four weeks, as recurrence following simple [[incision and drainage]] is common.<ref name=Omole2003/><ref name=Lee2015/> A surgical procedure known as [[marsupialization]] may be used or, if the problems persist, the entire gland may be removed.<ref name=Omole2003/> Removal is sometimes recommended in those older than 40 to ensure cancer is not present.<ref name=Omole2003/> [[Antibiotics]] are not generally needed.<ref name=Omole2003/> <!-- Epidemiology --> Bartholin's cysts affect about two percent of women at some point in their life.<ref name=Omole2003/> They most commonly occur during the childbearing years.<ref name=Omole2003/> The disease is named after [[Caspar Bartholin the Younger|Caspar Bartholin]] who accurately described the glands in 1677.<ref name=Kn2012>{{cite book |last1=Knaus |first1=John V. |last2=Isaacs |first2=John H. |title=Office Gynecology: Advanced Management Concepts |date=2012 |publisher=Springer Science & Business Media |isbn=9781461243403 |page=266 |url=https://books.google.ca/books?id=dgnpBwAAQBAJ&pg=PA266 |language=en}}</ref> The underlying mechanism of the disease was determined in 1967 by Buford Word.<ref name=Kn2012/><ref>{{cite book |title=Williams Gynecology |date=2012 |publisher=McGraw Hill Professional |isbn=9780071804653 |page=1063 |edition=2}}</ref> ==Signs and symptoms== Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,<ref name=Omole2003/> or sexual intercourse ([[dyspareunia]]).<ref name=Eilber2003 /> They are usually between 1 and 4&nbsp;cm, and are located just medial to the [[labia minora]]. Most Bartholin's cysts only affect the left ''or'' the right side ([[unilateral]]). Small cysts are usually not painful, but very large cysts can cause significant pain. ==Pathophysiology== A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked.<ref name=Eilber2003>{{cite journal|last=Eilber|first=Karyn Schlunt|author2=Raz, Shlomo|title=Benign Cystic Lesions of the Vagina: A Literature Review|journal=The Journal of Urology|date=September 2003|volume=170|issue=3|pages=717–722|doi=10.1097/01.ju.0000062543.99821.a2|pmid=12913681}}</ref> Blockage may be caused by an infection or a mucus plug.<ref name=Eilber2003 /> The secretions from the Bartholin's gland are retained, forming a cyst.<ref name=Omole2003/> ==Diagnosis== Other conditions that may present similarly include [[hidradenoma papilliferum]], [[lipoma]]s, [[epidermoid cysts]] and [[Skene's duct cyst]]s among others.<ref name=Omole2003/> In those who are more than 40 years of age a [[biopsy]] may be recommended to ensure cancer is not present.<ref name=Omole2003/> ==Treatment== Treatment may not be necessary when Bartholin's cysts cause no symptoms. Small, asymptomatic cysts can be observed over time to assess their development. In cases that require intervention, 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.<ref>[http://bestpractice.bmj.com/best-practice/monograph/1060/treatment/step-by-step.html Bartholin's cyst] from BestPractice, BMJ Publishing Group. Last updated: Apr 26, 2013</ref> Catheterization is a minor procedure that can be performed in an office setting. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.<ref name=Omole2003/> The balloon is then 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{{Citation needed|date=October 2019}}. The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place{{Citation needed|date=October 2019}}. Cysts may also be opened permanently, a procedure called [[marsupialization]],<ref name="pmid17355304">{{cite journal |vauthors=Haider Z, Condous G, Kirk E, Mukri F, Bourne T |title=The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study |journal=Aust N Z J Obstet Gynaecol |volume=47 |issue=2 |pages=137–140 |date=April 2007 |pmid=17355304 |doi=10.1111/j.1479-828X.2007.00700.x }}</ref> in which an opening to the gland is formed with stitches to hold the secretion channel open. If a 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. 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, but [[surgery|surgical]] or [[laser surgery|laser]] removal of a cyst makes it less likely that a new one will form at the same site. Those with a cyst are more likely than those without a cyst 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. ==Epidemiology== Two percent of women will have a Bartholin's gland cyst at some point in their lives.<ref name=Omole2003/> They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years.<ref name=":1">{{cite journal |last1=Yuk |first1=Jin-Sung |last2=Kim |first2=Yong-Jin |last3=Hur |first3=Jun-Young |last4=Shin |first4=Jung-Ho |title=Incidence of Bartholin duct cysts and abscesses in the Republic of Korea |journal=International Journal of Gynecology & Obstetrics |volume=122 |issue=1 |pages=62–4 |year=2013 |pmid=23618035 |doi=10.1016/j.ijgo.2013.02.014 }}</ref> The incidence of Bartholin duct cysts increases with age until [[menopause]], and decreases thereafter.<ref name=":1" /> Hispanic women may be more often affected than white women and black women.<ref name=Omole2003/> The risk of developing a Bartholin's gland cyst increases with the number of childbirths.<ref name=Omole2003/> ==References== {{reflist}} == External links == {{Medical resources | ICD10 = {{ICD10|N|75|0|N|70}} | ICD9 = {{ICD9|616.2}} | ICDO = | OMIM = | MedlinePlus = 001489 | MeSH = | GeneReviewsNBK = | GeneReviewsName = }} {{Diseases of the pelvis and genitals}} {{DEFAULTSORT:Bartholin's Cyst}} [[Category:Inflammatory diseases of female pelvic organs]] [[Category:RTT]]'