Bartholin’s cyst: symptoms and causes

When women feel sexually aroused, the Bartholin’s glands, located between the vagina and vulva, produce fluid during sexual activities. They are usually not 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 gland’s duct becomes blocked, a cyst forms. If 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 the touch, which can cause discomfort and pain during sex.

What is Bartholin’s cyst?

A Bartholin cyst occurs when the duct of the Bartholin gland becomes blocked, causing fluid to build up and form a cyst. “On either side of the vaginal opening are two small glands, known as Bartholin’s glands,” says obstetrician and gynecologist Dr. Rashmi N. They are responsible for producing fluid that lubricates the vagina during sexual activities.

When a duct becomes blocked, this fluid builds up, leading to the formation of a lump or swelling, often near the lower vaginal lips. According to Britain, the cyst usually affects women who are sexually active National Health Service. It is usually noticed at the onset of puberty and the risk increases with age until women reach menopause, according to a 2023 study published by StatPearls.

What are the symptoms of Bartholin’s cyst?

The cyst can vary in size, and while smaller ones are usually painless, larger cysts 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 gynecologist Dr. Neha Khandelwal. Knowing the symptoms can help you avoid complications.

1. Symptoms of a small or uninfected Bartholin cyst

If the cyst is as small as a pea, you may feel a soft, smooth lump near the vaginal opening in the early stages. It can go unnoticed because it does not cause any discomfort or pain. When the cyst is not infected, the skin over it generally remains normal in appearance, with no signs of inflammation or irritation.

2. Symptoms of a large or growing Bartholin cyst

As the cyst gets larger, 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. According to the United Kingdom, you may feel pain around the vagina during sex, walking or sitting National Health Service.

3. Symptoms of Infected Bartholin Cyst

When 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 the touch and may worsen when you move. The skin around the cyst may become red, warm and tender, indicating an infection.
If the infection spreads, it can cause fever and chills, which means your body is trying to fight the infection. In some cases, the cyst may rupture, releasing thick, yellow or greenish pus. This may provide temporary relief, but you should see a doctor to prevent further infection.

4. Symptoms of chronic or recurrent cysts

“Some women experience recurring Bartholin cysts, especially if the duct becomes blocked repeatedly,” says Dr. Khandelwal. Chronic cysts may be smaller but cause discomfort over time. Repeated infections or cysts can lead to scarring, which can 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 mainly caused by the blockage of ducts in the Bartholin’s glands, which can occur due to infections, inflammation, or physical injury,” says Dr. Rashmi. When their ducts become clogged, the fluid they produce cannot drain properly, leading to the formation of a cyst.

1. Infections

The blockage is often related to bacterial infections, with the most common bacteria being Escherichia coli (E. coli). It is normally found in the intestinal tract and can travel to the genital area and infect the tracts. Other bacteria that can cause obstructions include Staphylococcus and Streptococcus, as well as Neisseria gonorrhea and Chlamydia trachomatis which cause sexually transmitted infections (STDs). Infections such as 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 can block the Bartholin’s gland duct. This can happen through activities such as cycling or horse riding. It can also happen during sexual activity, which can lead to friction or pressure on the glands.

3. Inflammation

Vaginal itching or irritation can have many reasons. One of the main causes is the use of products that are more like irritants. The list includes soaps with harsh chemicals, feminine hygiene products and deodorants. “This irritation can contribute to gland inflammation and increase the risk of cyst development,” says Dr. Khandelwal.

How to diagnose Bartholin’s cyst?

The diagnosis of Bartholin’s cyst typically includes:

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 present, the cyst will usually look like a soft or firm lump near the vaginal opening.

2. Symptom overview

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 whether 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 cotton swab to test for bacterial infections, including STDs. “Testing for STDs is especially important if the infection could come from sexual transmission,” says Dr. Khandelwal.

4. Biopsy

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

How to treat Bartholin’s cyst?

Surgical intervention may be required to treat recurrent cysts. Marsupialization, in which a surgeon cuts open the cyst and drains the fluid, is the treatment of choice for recurring lesions, according to research published in the American General Practitioner’s Journal in 2019. “But many small and asymptomatic cysts do not require medical intervention and may disappear on their own,” says Dr. Rashmi.

The following can also be done:

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

Frequently Asked Questions (FAQs)

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

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

2. Can tight pants cause Bartholin’s cyst?

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

3. Can Bartholin Cysts Be Cancer?

Usually, Bartholin’s cysts are not malignant. However, women over 40 should consult a doctor if a cyst persists, as in some cases malignant tumors can arise from the Bartholin’s gland.