What is a Bartholin cyst?
As the cyst grows, the cyst feels like a painless lump or mass near the vaginal opening. The swelling is usually on one side of the vaginal opening.
The Bartholin glands are located on each side of the vaginal opening and they secrete a fluid that lubricates the vagina. Sometimes the openings of the Bartholin glands can be obstructed due to injury or infection, causing fluid to accumulate in the gland that results in a cyst called Bartholin cyst. The swelling is usually painless but can become infected causing pus accumulation and pain. This is called Bartholin abscess. Safe sexual practices, such as using condoms and maintaining good hygiene habits, can help prevent infection of a cyst.
Conservative home remedies may be used to treat Bartholin cysts, but most cases are treated surgically because they can recur, worsen or become infected. If the Bartholin cyst is infected by bacteria, including sexually transmitted infections, antibiotics and painkillers would be required. After Bartholin cyst drainage, the doctor would recommend certain self-care measures to care for the wound and healing takes about 1 to 2 weeks.
What are the signs and symptoms of Bartholin cysts?
Small Bartholin cysts that are not infected usually go unnoticed. As the cyst grows, the cyst feels like a painless lump or mass near the vaginal opening. The swelling is usually on one side of the vaginal opening.
A Bartholin cyst can become infected (called Bartholin abscess) and the patient may experience the following
- Painful swelling near the vaginal opening
- Tenderness
- Fever
- Difficulty/discomfort while walking or sitting
- Pain during sexual intercourse
How is a Bartholin cyst treated?
Early, asymptomatic Bartholin cysts usually do not require any treatment. The treatment depends on the size of the cyst, the discomfort level of the patient and whether or not the cyst is infected. Treatment options include
- Sitz baths: Soaking in a tub filled with a few inches of warm water (sitz bath). This may help the cyst rupture and drain by itself. Sitz baths may be done several times a day for 3 to 7 days or as advised by the doctor.
- Surgical drainage: Surgical drainage is required for Bartholin cysts that recur or cause discomfort or pain. Drainage of the cyst is usually done under local anesthesia or intravenous sedation. The doctor makes a small incision over the cyst and drains the fluid. A small tube (catheter) is placed in the incision within the cyst for about 6 weeks. This helps to continuously drain out the fluid that accumulates, allowing for complete drainage.
- Marsupialization: If cysts recur, a marsupialization procedure may be done. The doctor places sutures (stitches) on either side of the incision, creating a small permanent opening about 6 mm in diameter. A catheter may be placed for a few days to drain the fluid completely and help prevent a recurrence.
- Antibiotics: Antibiotics may be prescribed if the cyst is infected or to avoid post-procedure infection following surgical drainage.
- Painkillers: Painkillers help decrease pain and inflammation of an infected cyst or after surgical drainage.
Self-care after surgical drainage of the cyst
- Sitz bath: Patients may be advised to begin taking sitz baths after the packing is removed. A sitz bath can help reduce swelling and pain. Sitz baths may be prepared with just warm water or warm water mixed with a spoon of Epsom salt or an antiseptic solution prescribed by the doctor. A sitz bath may be taken 3 to 4 times a day for 10 minutes every time for 3 to 5 days or for as long as the doctor advises. Place a clean towel on the bottom of the bathtub. Fill the bathtub with warm water up to hip level. A ready sitz bath that fits in the toilet is available as well. The genital area should be wiped dry using a clean towel.
- Wear a sanitary napkin: Wear a sanitary napkin to help absorb discharge from the wound, which may take about 2 weeks to resolve.
- Patients are advised to wear loose-fitting underwear and clothes made of breathable material like cotton.
- Patients can perform daily activities after 2 to 3 days, but should avoid specific activities like exercise, sports or sexual intercourse until the doctor approves. Otherwise, the drain may fall out and increase the risk of infection.
- The genital area should be kept clean and dry. Patients are advised to wipe from front to back and shower at least once a day.
When to see a doctor
- Worsening pain and swelling
- Fever
- New lumps in the area
- Pain and swelling that doesn’t decrease after a few days of surgical drainage despite following aftercare instructions