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Bartholin's cyst

A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked.[4] Small cysts may result in minimal or no symptoms.[1] Larger cysts may result in swelling on one side of the vaginal opening, as well as pain during sex or walking.[4] If the cyst becomes infected, an abscess can occur, which is typically red and very painful.[3] If there are no symptoms, no treatment is needed.[3][4] Bartholin's cysts affect about 2% of women at some point in their life.[3] They most commonly occur during childbearing years.[3]

Bartholin's cyst
Other namesBartholin duct cyst, Bartholin gland cyst, cyst of Bartholin gland,[1] bartholinitis[2]
Bartholin's cyst of the right side
SpecialtyGynecology
SymptomsSwelling of one side of the vaginal opening, pain, sometimes no symptoms[1]
ComplicationsAbscess[3]
Usual onsetChildbearing age[3]
CausesUnknown[4]
Diagnostic methodBased on symptoms and examination[4]
Differential diagnosisSebaceous cyst, hernia, hidradenitis suppurativa, folliculitis, vulvar cancer, hematoma, gonorrhea, syphilis, genital wart[5][6]
TreatmentPlacement of a Word catheter, incision and drainage, marsupialization, sitz baths[5][4]
Frequency2% of women[3]

When the cyst becomes uncomfortable or painful, drainage is recommended.[3] The preferred method is the insertion of a Word catheter for four weeks, as recurrence following simple incision and drainage is common.[3][5] A surgical procedure known as marsupialization may be used or, if the problems persist, the entire gland may be removed.[3] Removal is sometimes recommended in those older than 40 to ensure cancer is not present.[3] Antibiotics are not generally needed to treat a Bartholin's cyst.[3]

The cause of a Bartholin's cyst is unknown.[4] An abscess results from a bacterial infection, but it is not usually a sexually transmitted infection (STI).[7] Rarely, gonorrhea may be involved.[4][6] Diagnosis is typically based on symptoms and examination.[4] In women over the age of 40, a tissue biopsy is often recommended to rule out cancer.[5][4]

The cyst is named after Caspar Bartholin who accurately described the glands in 1677.[8] The underlying mechanism of the cyst was determined in 1967 by the obstetrician Samuel Buford Word.[9][8][10]

Signs and symptoms edit

Most Bartholin's cysts do not cause any symptoms, although some may cause pain during walking, sitting,[3] or sexual intercourse (dyspareunia).[11] 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). While small cysts are usually not painful, larger cysts can cause significant pain.[citation needed]

Pathophysiology edit

A Bartholin's gland cyst develops when the duct that drains the gland becomes blocked.[11] Blockage may be caused by an infection or a mucus plug.[11] The secretions from the Bartholin's gland are retained, forming a cyst.[3]

Diagnosis edit

Other conditions that may present similarly include hidradenoma papilliferum, lipomas, epidermoid cysts and Skene's duct cysts, among others conditions.[3] In women who are more than 40 years, a biopsy may be recommended to rule out cancer.[3]

Treatment edit

If the Bartholin's cyst is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. Sitz baths may be useful in draining minor cysts. This is a conservative treatment that involves soaking the vaginal area in a few inches of warm water. It is generally recommended to do this for ten minutes at a time, up to four times per day. This treatment can sometimes cause cysts to spontaneously drain without further intervention.[12]

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, to alleviate swelling and discomfort.[13]

Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst.[3] The balloon is then inflated to keep it in place. A sample of purulent discharge can be sent to a lab for culturing and a biopsy may also be done.[12] The catheter stays in place for 2 to 4 weeks so the fluid can drain and allows a normal gland opening to form (after which the catheter is removed).[14] The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.[15] Catheterization may be performed multiple times if recurrence occurs.[12] At this point, antibiotics will typically be given in addition to the catheter. Some commonly prescribed antibiotics include Doxycycline, Azithromycin, Ciprofloxacin, and Trimethoprim/sulfamethoxazole, among many others. These antibiotics are chosen to ensure coverage of the most common bacterial pathogens such as Staphylococcus (including Methicillin-resistant Staphylococcus aureus), Streptococcus, and Escherichia coli.[16] Catheterization cannot be performed in individuals with a latex allergy as the catheter used is made of latex.[12]

Cysts may also be opened permanently, a procedure called marsupialization.[14] This involves opening the gland through an incision to ensure that the secretion channel remains open. If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Non-prescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort and reduce pain. Warm compresses can also speed up healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.[12]

Bartholin's cysts can be treated in the same way for pregnant women as non-pregnant women. The only treatment that should be used with caution in pregnant women is Bartholin gland excision (surgical removal of the gland). This is due to the increased risk for bleeding.[12]

Prognosis edit

While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgical or 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.

A randomized control trial (the WoMan trial) was performed in the Netherlands and England from 2010 to 2014. Women with bartholin's cysts were randomly assigned to receive treatment via Word catheter or marsupialization to compare rate of recurrence over a 1-year period. This trial found that recurrence rates were quite similar between the two treatments. Recurrence occurred in 12% of women in the catheter group and 10% of women in the marsupialization group. They did find that the frequency of use of analgesics was greater in the marsupialization group than the catheter group.[17]

Epidemiology edit

Two percent of women will have a Bartholin's gland cyst at some point in their lives.[3] 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.[18] The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter.[18] Hispanic women may be more often affected than white women and black women.[3] The risk of developing a Bartholin's gland cyst increases with the number of childbirths.[3]

References edit

  1. ^ a b c WHO Classification of Tumours Editorial Board, ed. (2020). "10. Tumours of the vulva: Bartholin gland cyst". Female genital tumours: WHO Classification of Tumours. Vol. 4 (5th ed.). Lyon (France): International Agency for Research on Cancer. p. 440. ISBN 978-92-832-4504-9.
  2. ^ Zink C (2011). Dictionary of Obstetrics and Gynecology. De Gruyter. p. 24. ISBN 978-3-11085-727-6. Retrieved November 27, 2023.
  3. ^ a b c d e f g h i j k l m n o p q r s t Omole F, Simmons BJ, Hacker Y (July 2003). "Management of Bartholin's duct cyst and gland abscess". American Family Physician. 68 (1): 135–140. PMID 12887119.
  4. ^ a b c d e f g h i j Kilpatrick CC. "Bartholin Gland Cysts". Merck Manuals Professional Edition. Retrieved 12 September 2018.
  5. ^ a b c d Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–25. doi:10.1159/000365683. PMC 4483306. PMID 26195958.
  6. ^ a b Ferri F (2017). Ferri's clinical advisor 2018 : 5 books in 1. Elsevier Canada. p. 175. ISBN 978-0-323-28049-5.
  7. ^ Marx JA (2014). "Skin and Soft Tissue Infections". Rosen's emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. Chapter 137. ISBN 978-1-4557-0605-1.
  8. ^ a b Knaus JV, Isaacs JH (2012). Office Gynecology: Advanced Management Concepts. Springer Science & Business Media. p. 266. ISBN 978-1-4612-4340-3.
  9. ^ Baskett TF (2019). Mr. United Kingdom: Cambridge University Press. pp. 455–457. ISBN 978-1-108-42170-6.
  10. ^ Williams Gynecology (2 ed.). McGraw Hill Professional. 2012. p. 1063. ISBN 978-0-07-180465-3.
  11. ^ a b c Eilber KS, Raz S (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.
  12. ^ a b c d e f Lee WA, Wittler M (5 July 2023). "Bartholin Gland Cyst". StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  13. ^ Stockdale CK, Boardman LA (28 June 2022). Anderson R, Ault K (eds.). "Bartholin's cyst". BestPractice. BMJ Publishing Group.
  14. ^ a b 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". The Australian & New Zealand Journal of Obstetrics & Gynaecology. 47 (2): 137–140. doi:10.1111/j.1479-828X.2007.00700.x. PMID 17355304. S2CID 36752877.
  15. ^ Reif P, Elsayed H, Ulrich D, Bjelic-Radisic V, Häusler M, Greimel E, et al. (July 2015). "Quality of life and sexual activity during treatment of Bartholin's cyst or abscess with a Word catheter". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 190: 76–80. doi:10.1016/j.ejogrb.2015.03.008. PMID 25800788.
  16. ^ Lee MY, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A (May 2015). "Clinical Pathology of Bartholin's Glands: A Review of the Literature". Current Urology. 8 (1): 22–25. doi:10.1159/000365683. PMC 4483306. PMID 26195958.
  17. ^ Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren P, et al. (January 2017). "Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial". BJOG. 124 (2): 243–249. doi:10.1111/1471-0528.14281. PMID 27640367.
  18. ^ a b Yuk JS, Kim YJ, Hur JY, Shin JH (July 2013). "Incidence of Bartholin duct cysts and abscesses in the Republic of Korea". International Journal of Gynaecology and Obstetrics. 122 (1): 62–64. doi:10.1016/j.ijgo.2013.02.014. PMID 23618035. S2CID 23981470.

External links edit

bartholin, cyst, occurs, when, bartholin, gland, within, labia, becomes, blocked, small, cysts, result, minimal, symptoms, larger, cysts, result, swelling, side, vaginal, opening, well, pain, during, walking, cyst, becomes, infected, abscess, occur, which, typ. A Bartholin s cyst occurs when a Bartholin s gland within the labia becomes blocked 4 Small cysts may result in minimal or no symptoms 1 Larger cysts may result in swelling on one side of the vaginal opening as well as pain during sex or walking 4 If the cyst becomes infected an abscess can occur which is typically red and very painful 3 If there are no symptoms no treatment is needed 3 4 Bartholin s cysts affect about 2 of women at some point in their life 3 They most commonly occur during childbearing years 3 Bartholin s cystOther namesBartholin duct cyst Bartholin gland cyst cyst of Bartholin gland 1 bartholinitis 2 Bartholin s cyst of the right sideSpecialtyGynecologySymptomsSwelling of one side of the vaginal opening pain sometimes no symptoms 1 ComplicationsAbscess 3 Usual onsetChildbearing age 3 CausesUnknown 4 Diagnostic methodBased on symptoms and examination 4 Differential diagnosisSebaceous cyst hernia hidradenitis suppurativa folliculitis vulvar cancer hematoma gonorrhea syphilis genital wart 5 6 TreatmentPlacement of a Word catheter incision and drainage marsupialization sitz baths 5 4 Frequency2 of women 3 When the cyst becomes uncomfortable or painful drainage is recommended 3 The preferred method is the insertion of a Word catheter for four weeks as recurrence following simple incision and drainage is common 3 5 A surgical procedure known as marsupialization may be used or if the problems persist the entire gland may be removed 3 Removal is sometimes recommended in those older than 40 to ensure cancer is not present 3 Antibiotics are not generally needed to treat a Bartholin s cyst 3 The cause of a Bartholin s cyst is unknown 4 An abscess results from a bacterial infection but it is not usually a sexually transmitted infection STI 7 Rarely gonorrhea may be involved 4 6 Diagnosis is typically based on symptoms and examination 4 In women over the age of 40 a tissue biopsy is often recommended to rule out cancer 5 4 The cyst is named after Caspar Bartholin who accurately described the glands in 1677 8 The underlying mechanism of the cyst was determined in 1967 by the obstetrician Samuel Buford Word 9 8 10 Contents 1 Signs and symptoms 2 Pathophysiology 3 Diagnosis 4 Treatment 5 Prognosis 6 Epidemiology 7 References 8 External linksSigns and symptoms editMost Bartholin s cysts do not cause any symptoms although some may cause pain during walking sitting 3 or sexual intercourse dyspareunia 11 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 While small cysts are usually not painful larger cysts can cause significant pain citation needed Pathophysiology editA Bartholin s gland cyst develops when the duct that drains the gland becomes blocked 11 Blockage may be caused by an infection or a mucus plug 11 The secretions from the Bartholin s gland are retained forming a cyst 3 Diagnosis editOther conditions that may present similarly include hidradenoma papilliferum lipomas epidermoid cysts and Skene s duct cysts among others conditions 3 In women who are more than 40 years a biopsy may be recommended to rule out cancer 3 Treatment editIf the Bartholin s cyst is not painful or uncomfortable treatment may not be necessary Small asymptomatic cysts can be observed over time to assess their development Sitz baths may be useful in draining minor cysts This is a conservative treatment that involves soaking the vaginal area in a few inches of warm water It is generally recommended to do this for ten minutes at a time up to four times per day This treatment can sometimes cause cysts to spontaneously drain without further intervention 12 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 to alleviate swelling and discomfort 13 Catheterization is a minor procedure that can be performed locally as an outpatient procedure A small tube with a balloon on the end known as a Word catheter may be inserted into the cyst 3 The balloon is then inflated to keep it in place A sample of purulent discharge can be sent to a lab for culturing and a biopsy may also be done 12 The catheter stays in place for 2 to 4 weeks so the fluid can drain and allows a normal gland opening to form after which the catheter is removed 14 The catheters do not generally impede normal activity but sexual intercourse is generally abstained from while the catheter is in place 15 Catheterization may be performed multiple times if recurrence occurs 12 At this point antibiotics will typically be given in addition to the catheter Some commonly prescribed antibiotics include Doxycycline Azithromycin Ciprofloxacin and Trimethoprim sulfamethoxazole among many others These antibiotics are chosen to ensure coverage of the most common bacterial pathogens such as Staphylococcus including Methicillin resistant Staphylococcus aureus Streptococcus and Escherichia coli 16 Catheterization cannot be performed in individuals with a latex allergy as the catheter used is made of latex 12 Cysts may also be opened permanently a procedure called marsupialization 14 This involves opening the gland through an incision to ensure that the secretion channel remains open If a cyst is infected it may break open and start to heal on its own after 3 to 4 days Non prescription pain medication such as ibuprofen relieves pain and a sitz bath may increase comfort and reduce pain Warm compresses can also speed up healing If a Bartholin gland abscess comes back several times the gland and duct can be surgically removed 12 Bartholin s cysts can be treated in the same way for pregnant women as non pregnant women The only treatment that should be used with caution in pregnant women is Bartholin gland excision surgical removal of the gland This is due to the increased risk for bleeding 12 Prognosis editWhile Bartholin cysts can be quite painful they are not life threatening New cysts cannot absolutely be prevented from forming but surgical or 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 A randomized control trial the WoMan trial was performed in the Netherlands and England from 2010 to 2014 Women with bartholin s cysts were randomly assigned to receive treatment via Word catheter or marsupialization to compare rate of recurrence over a 1 year period This trial found that recurrence rates were quite similar between the two treatments Recurrence occurred in 12 of women in the catheter group and 10 of women in the marsupialization group They did find that the frequency of use of analgesics was greater in the marsupialization group than the catheter group 17 Epidemiology editTwo percent of women will have a Bartholin s gland cyst at some point in their lives 3 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 18 The incidence of Bartholin duct cysts increases with age until menopause and decreases thereafter 18 Hispanic women may be more often affected than white women and black women 3 The risk of developing a Bartholin s gland cyst increases with the number of childbirths 3 References edit a b c WHO Classification of Tumours Editorial Board ed 2020 10 Tumours of the vulva Bartholin gland cyst Female genital tumours WHO Classification of Tumours Vol 4 5th ed Lyon France International Agency for Research on Cancer p 440 ISBN 978 92 832 4504 9 Zink C 2011 Dictionary of Obstetrics and Gynecology De Gruyter p 24 ISBN 978 3 11085 727 6 Retrieved November 27 2023 a b c d e f g h i j k l m n o p q r s t Omole F Simmons BJ Hacker Y July 2003 Management of Bartholin s duct cyst and gland abscess American Family Physician 68 1 135 140 PMID 12887119 a b c d e f g h i j Kilpatrick CC Bartholin Gland Cysts Merck Manuals Professional Edition Retrieved 12 September 2018 a b c d Lee MY Dalpiaz A Schwamb R Miao Y Waltzer W Khan A May 2015 Clinical Pathology of Bartholin s Glands A Review of the Literature Current Urology 8 1 22 25 doi 10 1159 000365683 PMC 4483306 PMID 26195958 a b Ferri F 2017 Ferri s clinical advisor 2018 5 books in 1 Elsevier Canada p 175 ISBN 978 0 323 28049 5 Marx JA 2014 Skin and Soft Tissue Infections Rosen s emergency medicine concepts and clinical practice 8th ed Philadelphia PA Elsevier Saunders pp Chapter 137 ISBN 978 1 4557 0605 1 a b Knaus JV Isaacs JH 2012 Office Gynecology Advanced Management Concepts Springer Science amp Business Media p 266 ISBN 978 1 4612 4340 3 Baskett TF 2019 Mr United Kingdom Cambridge University Press pp 455 457 ISBN 978 1 108 42170 6 Williams Gynecology 2 ed McGraw Hill Professional 2012 p 1063 ISBN 978 0 07 180465 3 a b c Eilber KS Raz S 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 a b c d e f Lee WA Wittler M 5 July 2023 Bartholin Gland Cyst StatPearls Internet Treasure Island FL StatPearls Publishing Stockdale CK Boardman LA 28 June 2022 Anderson R Ault K eds Bartholin s cyst BestPractice BMJ Publishing Group a b 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 The Australian amp New Zealand Journal of Obstetrics amp Gynaecology 47 2 137 140 doi 10 1111 j 1479 828X 2007 00700 x PMID 17355304 S2CID 36752877 Reif P Elsayed H Ulrich D Bjelic Radisic V Hausler M Greimel E et al July 2015 Quality of life and sexual activity during treatment of Bartholin s cyst or abscess with a Word catheter European Journal of Obstetrics Gynecology and Reproductive Biology 190 76 80 doi 10 1016 j ejogrb 2015 03 008 PMID 25800788 Lee MY Dalpiaz A Schwamb R Miao Y Waltzer W Khan A May 2015 Clinical Pathology of Bartholin s Glands A Review of the Literature Current Urology 8 1 22 25 doi 10 1159 000365683 PMC 4483306 PMID 26195958 Kroese JA van der Velde M Morssink LP Zafarmand MH Geomini P van Kesteren P et al January 2017 Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland WoMan trial a randomised clinical trial BJOG 124 2 243 249 doi 10 1111 1471 0528 14281 PMID 27640367 a b Yuk JS Kim YJ Hur JY Shin JH July 2013 Incidence of Bartholin duct cysts and abscesses in the Republic of Korea International Journal of Gynaecology and Obstetrics 122 1 62 64 doi 10 1016 j ijgo 2013 02 014 PMID 23618035 S2CID 23981470 External links edit Retrieved from https en wikipedia org w index php title Bartholin 27s cyst amp oldid 1221343400, wikipedia, wiki, book, books, library,

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