When women feel sexually aroused, the Bartholin's glands, located between the vagina and vulva, produce fluid during sexual activities. They are not usually visible to the naked eye, but they make their presence felt by producing a fluid that helps reduce friction during sexual activities. But when the duct of the gland becomes blocked, a cyst gets formed. If the Bartholin's cyst is small, it is often painless and may go unnoticed. However, if the cyst becomes large or infected, it can become very painful to touch, which can cause discomfort and pain during sex.

What is Bartholin's cyst?

A Bartholin's cyst forms when the duct of the Bartholin's gland becomes blocked, causing fluid to accumulate and create a cyst. "Two small glands, which are known as the Bartholin's glands, are present on either side of the vaginal opening," says obstetrician and gynaecologist Dr Rashmi N. They are responsible for producing fluid that lubricates the vagina during sexual activities.

Bartholin’s cyst can be painful if it is big. Image courtesy: Adobe Stock

When a duct gets obstructed, this fluid builds up, leading to the formation of a lump or swelling, often near the lower vaginal lips. The cyst usually affects women who are sexually active, according to the UK's National Health Service. It is most often noted at the onset of puberty and the risk increases with age until women reach the menopause stage, as per a 2023 research published by StatPearls.

What are the symptoms of Bartholin's cyst?

The cyst can range in size, and while smaller ones are typically painless, larger ones can cause discomfort or pain. "It is painful especially if it becomes infected, and forms an abscess (a collection of pus in the body)," says obstetrician and gynaecologist Dr Neha Khandelwal. Knowing the symptoms can help you avoid complications.

1. Symptoms of small or non-infected Bartholin's cyst

In the early stages, if the cyst is as small as a pea, you may feel a soft, smooth lump near the vaginal opening. It may go unnoticed, as it does not cause any discomfort or pain. When the cyst is not infected, the skin over it generally remains normal in appearance, without any signs of inflammation or irritation.

2. Symptoms of large or growing Bartholin's cyst

As the cyst grows in size, it may become more noticeable as a lump or swelling on one side of the vaginal opening. It can be as small as a marble or as big as an egg. Larger cysts can cause discomfort, especially during physical activity. You may feel pain around the vagina area while having sex or walking or sitting down, according to the UK's National Health Service.

3. Symptoms of infected Bartholin's cyst

When a Bartholin's cyst becomes infected, it can lead to the formation of an abscess, and the symptoms are more severe. The cyst can become extremely painful to touch and can worsen when you move around. The skin around the cyst may become red, warm, and tender to the touch, indicating an infection.

If the infection spreads, it may trigger a fever, along with chills, meaning your body is trying to fight off the infection. In some cases, the cyst may rupture, releasing thick, yellow or greenish pus. This may provide temporary relief, but you need to go to a doctor to prevent further infection.

4. Symptoms of chronic or recurrent cysts

"Some women experience recurrent Bartholin's cysts, especially if the duct becomes repeatedly blocked," says Dr Khandelwal. Chronic cysts may be smaller but cause discomfort over time. Repeated infections or cysts can lead to scarring, which may cause persistent blockage of the duct and increase the risk of future cysts or abscesses.

What are the causes of Bartholin's cyst?

"The cyst is primarily caused by the blockage of ducts in the Bartholin’s glands, which can occur due to infections, inflammation, or physical injuries," says Dr Rashmi. When their ducts become obstructed, the fluid they produce cannot drain properly, leading to the formation of a cyst.

1. Infections

The blockage is often linked to bacterial infections, with common bacteria being Escherichia coli (E. coli). It is normally found in the intestinal tract, and can move to the genital area and infect the ducts. Other bacteria that may cause obstructions include Staphylococcus and Streptococcus, as well as Neisseria gonorrhea and Chlamydia trachomatis that cause sexually transmitted infections (STIs). Infections like gonorrhea and chlamydia can cause inflammation and swelling around the Bartholin’s glands, further preventing the normal outflow of fluid.

2. Injuries

Injury or trauma to the vaginal area can cause swelling or scar tissue, which may block the duct of the Bartholin's gland. This can happen from activities like cycling or riding a horse. It can also happen during sexual activity, which can lead to friction or pressure on the glands.

3. Inflammation

Vaginal itching or irritation can be due to many reasons. One of the major causes is using products that are more like irritants. The list includes soaps with harsh chemicals, feminine hygiene products, and deodorants. "This irritation may contribute to gland inflammation, and increase the risk of cyst development," says Dr Khandelwal.

How to diagnose Bartholin's cyst?

Diagnosis of Bartholin’s cyst typically involves:

1. Physical examination

During the pelvic exam, the doctor will inspect the external genital area, including the vaginal opening, and check for any swelling, lumps, or tenderness on either side of the vaginal opening. If it is present, the cyst will usually appear as a soft or firm lump near the vaginal opening.

2. Symptom review

The doctor will ask about any symptoms you have experienced, such as pain, discomfort, swelling, or fever. They may also ask about your sexual activity, history of infections, or trauma to the vaginal area. Pain during activities such as walking, sitting, or sex can help indicate if the cyst has become infected or not.

3. Testing for infections

If the cyst appears infected, the doctor may take a sample of the fluid or use a swab to test for bacterial infections, including STIs. "Testing for STIs is particularly important if the infection could have originated from sexual transmission," says Dr Khandelwal.

4. Biopsy

In women over 40 or if the cyst appears unusual or does not respond to treatment, the doctor may recommend a biopsy. This involves removing a small tissue sample from the cyst to test for Bartholin’s gland carcinoma, which is a rare cancer. A biopsy helps to confirm whether the cyst is benign (non-cancerous) or malignant.

Sitz bath may help to get relief from Bartholin’s cyst. Image courtesy: Adobe Stock

How to treat Bartholin's cyst?

A surgical procedure may be required for treating recurrent cysts. Marsupialization, in which a surgeon cuts the cyst open and drains the fluid, is the preferred treatment for recurrent lesions, as per research published in the American Family Physician journal in 2019. "But many small and asymptomatic cysts need no medical intervention and may go away on their own," says Dr Rashmi.

The following can also be done:

• Take sitz baths by soaking in warm water a few times a day to help the cyst drain on its own.
• Antibiotics may be given if the cyst is infected.
• In rare cases, the Bartholin's gland may be removed surgically.

Frequently asked questions (FAQs)

1. Can shaving or waxing cause Bartholin’s cyst?

Shaving does not cause Bartholin’s cyst, but it causes the skin or outer layer to be irritated. If it gets infected, it may block the Bartholin’s gland, and can lead to the formation of a cyst.

2. Can tight pants cause Bartholin’s cyst?

Tight-fitting clothes, especially worn around the vaginal area, can trap heat and moisture. This can cause itching, and genital infections and so, can lead to the development of a cyst.

3. Can Bartholin’s cysts be cancerous?

Most of the time, Bartholin’s cysts are not malignant. However, women over 40 should see a doctor if a cyst persists because in some cases, malignant tumors can arise from the Bartholin’s gland.

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