What is a Bartholin's cyst?
A Bartholin's cyst, also called a Bartholin's duct cyst, is a small growth just inside the opening of a woman’s vagina. Cysts are small fluid-filled sacs that are usually harmless.
A Bartholin's cyst can stay small and painless and may not cause any symptoms. However, the cyst can become infected, which can cause a painful collection of pus (an abscess) in the Bartholin’s gland.
Read more about the symptoms of a Bartholin’s cyst.
What causes a Bartholin’s cyst?
The Bartholin’s glands are a pair of pea-sized glands. They are found just behind and either side of the inner lips that surround the entrance to the vagina (the labia majora). The glands are not usually noticeable because they are rarely larger than 1cm (0.4 inches) across.
The Bartholin’s glands secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes, called ducts, into the vagina. If the ducts become blocked, they will fill with fluid and expand. This then becomes a cyst.
Read more about the causes of a Bartholin’s cyst.
When should I see my doctor?
Report any new lumps to your doctor so that they can confirm or rule out a diagnosis of a Bartholin’s cyst and check for infection or other conditions.
Also see your doctor if you have a cyst that becomes large or painful, or is uncomfortable when you sit or walk.
Several treatments are available to treat any pain or infection and, if necessary, drain the cyst. Most treatments involve a minor surgical procedure. However, Bartholin's cysts are known to come back in up to 38% of women.
If you do not have any symptoms, it's unlikely that you will need treatment.
Read more about treating a Bartholin’s cyst.
Who is affected?
According to estimates, around 2% of women will develop a Bartholin’s cyst. The condition usually affects sexually active women who are 20 to 30 years old.
The Bartholin’s glands do not start functioning until puberty, so Bartholin’s cysts do not usually affect children.
Bartholin's cyst symptoms
Most Bartholin's cysts do not cause any symptoms. However, you may feel a soft, painless lump in your labia (the two pairs of lips that surround the entrance to your vagina).
You may not know that you have a cyst until it is found during a routine cervical screening test or another gynaecological examination. A gynaecologist is a specialist in treating conditions of the female reproductive system.
If the cyst grows very large, it can become uncomfortable and noticeable. You may feel pain in your vulva (external sexual organs) when you walk, sit down or have sex.
Sometimes, the cyst can affect the outer pair of lips around the opening of the vagina (labia majora). One side may look swollen or bigger than usual.
If the cyst or gland becomes infected, it can cause an abscess. This is a painful collection of pus which often gets bigger over a few hours or days.
The cyst will become swollen, tender to touch and the skin around the abscess is likely to be red and hot. An abscess can also cause a high temperature of 38C (100.4F) or above.
When to see your doctor
See your doctor as soon as possible if the cyst does not improve after a few days of self-care treatment. If the cyst becomes large or painful, or if there are any other symptoms such as fever or vomiting, see your doctor immediately.
If it is painful and causes discomfort when you walk or sit, it is likely that it has developed into an abscess and you will need treatment to drain the fluid.
Read more about treatment for a Bartholin’s cyst.
Also visit your doctor or a sexual health clinic (GUM clinic) as soon as possible if you have symptoms such as vaginal discharge, itching or pain. You may have a sexually transmitted infection (STI).
If you have an STI, the sooner you receive treatment, the better.
Bartholin's cyst cancer
If you notice any swelling in your vagina or any changes such as pain or itching, see your doctor as they may need to do further tests.
In very rare cases, a Bartholin’s cyst could develop into Bartholin's cyst cancer. It is also important for your doctor to rule out vulval cancer.
Read more about how a Bartholin’s cyst is diagnosed.
Causes of a Bartholin's cyst
A Bartholin’s cyst is caused by an obstruction that blocks the tube, known as a duct, which leads from the Bartholin’s gland into the vagina. This leads to a build-up of fluid, which can turn into a cyst.
Several different types of bacteria can cause an infection that blocks the duct. Some types of bacteria can be passed on through sexual contact while others are found in the environment.
The following types of bacteria may cause a Bartholin’s cyst:
- Gonococcus – usually responsible for gonorrhoea (a sexually transmitted infection) and may be responsible for around a third of Bartholin’s cysts
- Chlamydia trachomatis – usually responsible for chlamydia (another STI)
- Escherichia coli – often responsible for food poisoning
- Streptococcus pneumoniae – responsible for pneumococcal infections, such as infections of the inner ear or sinuses
- Haemophilus influenzae – responsible for a number of infections such as epiglottitis, an infection of the epiglottis (the flap of tissue at the back of your throat)
As some of these bacteria are also responsible for sexually transmitted infections (STIs), such as gonorrhoea and chlamydia, you can protect yourself against them by having safer sex.
Diagnosing Bartholin’s cyst
Your doctor can diagnose a Bartholin’s cyst with a physical examination. The symptoms and appearance of a cyst are easily recognisable.
However, if you have other symptoms, such as vaginal discharge, your doctor may also advise that you have further tests to check for sexually transmitted infections (STIs).
In some cases, you may be advised to have a biopsy of the cyst. A biopsy involves taking a small sample of tissue so that it can be examined under a microscope.
A biopsy may be recommended because a growth in your vulva (your external sexual organs) can be a symptom of vulval cancer. This type of cancer is relatively rare, with just over 1,000 cases diagnosed in the UK each year.
If you notice any swelling in your vagina or any changes such as pain or itching, see your doctor.
Treatment for Bartholin’s cyst
If the Bartholin’s cyst is small and does not cause any symptoms, it's often better to leave it alone. However, you should still see your doctor if you notice a lump.
If you have pain around the cyst, your doctor may recommend that you:
- soak the cyst for 10–15 minutes in a few inches of warm water (it's easier in the bath) – you may do this several times a day for three or four days
- hold a warm compress (a flannel or cotton wool warmed with hot water) against the area
- use pain relief, such as paracetamol or ibuprofen
Always read the manufacturer’s instructions when using over-the-counter (OTC) medication.
Treating an abscess
If the cyst becomes an abscess (a painful collection of pus), you may also be prescribed antibiotics to clear the infection.
Once the infection has been treated, your doctor may still feel it necessary to drain the cyst, particularly if the abscess is large.
Bartholin's cyst incision and drainage
Drainage/balloon catheter insertion
When a Bartholin's cyst or abscess is inflamed, it may simply be cut open and drained if this is possible.
An alternative procedure for draining a cyst is known as balloon catheter insertion, or sometimes catheter placement or fistulisation.
This procedure is used to drain the fluid from the abscess or cyst and to create a permanent passage to drain away any future fluid that builds up.
You will have balloon catheter insertion as an outpatient, which means you won't need to stay in hospital overnight. It can be carried out under either local or general anaesthetic.
During the procedure, a cut is made in the abscess or cyst and the fluid is drained. A specially designed balloon catheter is inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.
The balloon is then filled with a small amount of salt water. This increases the size of the balloon so that it fills the cyst or abscess. If you have any pain, some of the solution can be removed to reduce the pressure slightly.
A stitch may be used to partially close the incision and the balloon catheter is held in place in the cyst. The catheter will stay in place while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon is drained and the balloon catheter removed.
A few small studies have reported that, after balloon catheter insertion, 83–97% of women healed well and their cysts or abscesses did not reoccur.
Possible complications of balloon catheter insertion include:
- pain from the catheter
- pain during sex
- swelling of the labia (the lips around the opening of the vagina)
If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used. In marsupialisation, the cyst is opened with an incision and the fluid is drained out.
The edges of the skin are then stitched in a way that prevents further fluid build-up by allowing it to drain out. This creates a pouch (similar to a kangaroo’s pouch, hence the name marsupialisation).
Marsupialisation is often carried out as a day case, so you will not have to stay in hospital overnight. It can be carried out under:
- local anaesthetic, where the area is numbed so you cannot feel anything but you remain conscious throughout the procedure
- general anaesthetic, where you are unconscious and cannot feel anything
Although complications after marsupialisation are rare, they can include:
- the abscess reoccurring
- pain – you may be given painkillers to ease any pain in the first 24 hours after the procedure
Bartholin's cyst removal
In some cases, it may be necessary to remove the Bartholin's cyst. This procedure is often considered to have the best long-term benefits, but requires an overnight stay in hospital.
There is also a higher risk of complications when the whole cyst is removed, including bleeding or blood collecting in the wound (haematoma).
These procedures are alternative ways of treating a Bartholin’s cyst, but are rarely used or are not widely available.
Silver nitrate gland ablation
Silver nitrate is a mixture of chemicals sometimes used in medicine to cauterise (burn) blood vessels to stop bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.
An incision is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).
The silver nitrate causes the cyst cavity to form into a small, solid lump. After two or three days, the piece of silver nitrate and the cyst cavity are removed or they may fall off on their own.
It is possible for the silver nitrate to burn some of the skin of your vulva when it is first used. One small study reported that this occurs in 20% of women.
Carbon dioxide laser
A laser is used to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then be:
- destroyed using the laser
- left attached but with a hole in it
During needle aspiration, a needle is used to drain the cyst.
Sometimes, this is combined with a procedure called alcohol sclerotherapy, where the cavity is then filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and then drained out.