Generality
Bartolini's cyst is a female pathology that involves the homonymous glands, located in the vulvar region, between the labia majora, near the vaginal orifice.
The disorder occurs following an obstruction of Bartolini's duct, which causes the gland to swell due to the stagnation of its secretion, from which the formation of a cyst follows. The reason why the fluid produced by Bartolini's glands finds it difficult to drain normally is not always identifiable. Rarely, Bartolini's cysts derive from inflammation (bartolinite), a sexually transmitted disease (such as gonorrhea and chlamydia) or from a congenital malformation of the genital tract.
Larger Bartolini cysts can cause an annoying sensation, especially during sexual intercourse and walking.
The diagnostic framework includes a gynecological examination and, sometimes, an excisional biopsy. Generally, Bartolini's cyst does not need treatment when it is small and not subject to recurrent infections. If the lesion becomes symptomatic or abscess, on the other hand, drainage of the gland may be necessary, with or without complete enucleation of the same ( bartolinectomy ).
What's this
Bartolini's cyst is a roundish formation that develops at the lower end of the vulvar skin folds (small and large lips), on the sides of the vestibule of the vagina.
Bartolini's cyst develops following an obstruction of the excretory duct, which causes the gland to swell due to stagnation or stasis of the viscous substance inside the duct itself. This fluid is normally produced to help lubricate the vaginal canal when a woman is sexually aroused.
Did you know that…
Bartholin's glands are mainly involved in inflammation (such as bartholinitis) and cyst formation ; these problems are common in women of reproductive age, particularly between the ages of 20 and 30.
Causes and Risk Factors
Bartolini's cyst falls into the category of vulvar cystic formations .
Bartolini's glands are two small ovaloid or roundish glands, located deeply and symmetrically arranged (one on each side) near the lateral and posterior wall of the vaginal orifice. Their function is to secrete a viscous and transparent liquid, used to lubricate the vaginal canal during sexual intercourse. Sometimes, the excretory ducts from which this fluid normally escapes become obstructed, causing the formation of a Bartolini cyst . The reason why this phenomenon occurs is not always known .
In some cases, Bartolini's cyst is related to traumatic injuries, infections and inflammatory processes . Less often, the condition results from the abnormal development of genital tract tissues (congenital malformation) or from a sexually transmitted disease such as gonorrhea and chlamydia.
Who is most at risk
Bartolini's cysts are the most common vulvar cystic formations: this condition affects about 2% of women, usually between 20 and 30 years of age . With time, however, the condition is less likely to manifest.
In fact, in peri-menopausal women, Bartolini's glands undergo a physiological involution . For this reason, the possible appearance of a lump or a vulvar mass requires an excisional biopsy, in order to exclude the presence of a malignant tumor.
Did you know that…
Bartolini's glands change their structure with age: in young girls, they have small dimensions (since they are not yet functioning in this period), while in sexually active adult women they reach their maximum volume. These structures then undergo a progressive involution and, after menopause, are atrophic.
Symptoms and Complications
Most Bartolini cysts do not cause symptoms, but if they become enlarged they can be annoying when sitting, walking or during sexual intercourse.
Bartolini's cysts: how they present themselves
Most of Bartolini's cysts are unilateral. Next to the vaginal orifice, it is possible to notice a swelling, similar to a nodule, painless and palpable.
The Bartolini cyst modifies or even deforms the normal appearance of the external genitalia: when they are large, these formations extend the large lips of the affected side and cause a vulvar asymmetry .
If the Bartolini cysts are affected by an infectious process, furthermore, swelling, redness, very intense pain and fever can occur.
Bartolini cysts: most common symptoms
When it is small, the Bartolini cyst can remain asymptomatic for a long time.
However, if it becomes very voluminous, the lesion can cause vulvar irritation, dyspareunia and tenderness during walking . Urination can also become difficult.
Sometimes, in the presence of Bartolini's cyst, the production of vaginal secretions is associated (usually yellowish).
Concurrent complications and pathologies
When the liquid contained within a Bartolini cyst becomes infected, an abscess can form (collection of pus due to the penetration of some germs, more frequently Escherichia coli, Neisseria gonorrhoeae and Chlamydia trachomatis ). In this case, the appearance of some fever and very intense pain is possible.
The abscesses of Bartolini's gland are sensitive to the touch, they become very bulky (they can reach the size of a walnut) and cause a reddening of the skin above them.
Diagnosis
Bartolini's cyst evaluation includes a specialist medical examination. With the physical examination, the gynecologist can carry out the correct diagnostic classification and indicate the most appropriate treatment for the case.
In women over the age of 40, an excisional biopsy is almost always performed to exclude any vulvar cancer.
Pelvic exam
If the Bartolini cyst is quite voluminous or causes symptoms, the doctor can observe or palpate it during the gynecological examination. Furthermore, from his appearance he can determine if he is infected.
In case of infections
If there are secretions, the doctor can send a sample to the laboratory to determine whether or not there are infections, including sexually transmitted diseases. If an abscess has developed, the doctor also performs the culture of the relative liquid.
Biopsy
In some cases, the signs of cancer of the vulva mimic those of the Bartolini cyst. Therefore, the doctor can perform a biopsy test to examine a lesion sample under the microscope and characterize it.
Usually, the biopsy is performed if the woman is over 40 years of age and the cyst appears to be irregularly shaped or has bumps.
Differential diagnosis
The differential diagnosis is made with other cystic and solid lesions of the vulva, such as:
- Epidermal inclusion cysts (round and asymptomatic bulges located in the labia majora);
- Papillary hydroadenoma (benign neoplasm that derives from the sweat glands, located mainly at the level of the labia minora);
- fibroma;
- Lipoma;
- Cyst of the Skene ducts.
Rarely, tumors of the vulva originate from the neoplastic transformation of the epithelial components of the Bartholin's gland. It should be noted that this pathology can be correlated with human papilloma virus infection.
The tumor of Bartolini's glands usually presents itself as an irregular, nodular and persistently hardened palpable vulvar neoformation. Belatedly, clinical signs such as excoriation, pain and itching appear. The lesion may become necrotic or ulcerated, sometimes causing bleeding or watery vaginal secretions.
Treatment and Remedies
In general, Bartolini's cyst does not require treatment when it is small, does not cause discomfort and is not the object of recurrent infections.
If the lesion is symptomatic or abscess, on the other hand, the doctor may indicate the use of surgical therapy through drainage, with or without complete enucleation of the gland (bartolinectomy).
Asymptomatic Bartolini cyst
When the Bartolini cyst does not cause symptoms or involves mild and bearable disorders, it is possible to make local sitz baths with hot water . This practice has a calming effect and can be useful to reduce congestion in the area. Alternatively, you can soak in a bathtub, filled with warm water for a few centimeters.
What are the sitz baths?
The sitz baths are baths that are made in a container with a particular shape, which allows the basin to be immersed. Depending on the needs, the water can be at varying temperatures, firm or current: in the case of vulvar itching, for example, warm half-wombs are useful, while cold and short-lasting ones produce an exciting effect on the nervous level.
The local sitz baths should be done 3 or 4 times a day and, to be useful, they should last 10-15 minutes each. Sometimes, with this treatment, the cysts disappear after a few days. If the sitz baths are ineffective, instead, it is advisable to consult the doctor.
When to consult a doctor
- Bartolini's cyst continues to swell or persists after several days, despite diving in hot water (in the tub or by sitz baths).
- Bartolini's cyst is painful and fever appears (these manifestations may indicate the evolution of the lesion in an abscess).
- Bartolini's cyst interferes with walking or does not allow sitting.
Bartolini's cyst symptomatic: surgery
Surgical treatment is indicated in women under the age of 40, who have symptomatic Bartolini cysts.
Usually, the emptying of cystic formation is ineffective, as it tends to reform.
Preferably, the creation of an opening from the duct of the gland to the surface of the vulva is indicated, so that, if the Bartolini cyst fills up again, it can be emptied.
The surgeon can proceed in one of the following ways:
- Surgical drainage with a Word catheter : a small incision is made in the cyst, so as to be able to insert a small tube (catheter) with a sort of balloon at the end. Once positioned, the latter swells and the catheter remains in place for 4-6 weeks to form a permanent opening before being removed. The presence of the catheter does not preclude the normal activities of the woman, although the sexual relationship can be annoying.
- Marsupialization : consists of a small incision of the cyst and of the externalization of its walls (in practice, the internal margins of the lesion are sutured to the surface of the vulva). This procedure may require general anesthesia.
Following these interventions, the patient can observe losses on the underwear; these are nothing but the secretions from Bartolini's cyst during its emptying. Running several warm sitz baths several times a day can help relieve discomfort and accelerate healing.
In some cases, the treatment may include the complete surgical removal of the Bartolini cyst ( bartolinectomy ) and the reconstruction of the normal anatomy of the affected lip.
Over 40 years of age
In women over 40, all vulvar cysts must be removed. The treatment involves the complete surgical removal of the cystic formation and the biopsy of a tissue sample to exclude that the lesion is a tumor.
Recurrences and management of complications
- If the Bartolini cyst has become complicated in an abscess, an adequate antibiotic therapy is prescribed by the doctor, followed by drainage to favor the escape of the purulent material, with or without resection of the affected gland. This approach allows a sudden improvement of vulvar pain. After surgery, the cyst walls retract, leaving a new orifice for secretions. Alternatively, it is possible to proceed with the surgical removal of the infected Bartolini cyst by bartolinectomy .
- Regardless of the treatment, Bartolini's cyst sometimes reforms. In case of relapses, marsupialization may be indicated, ie the gland affected by the pathological process is incised and left open to allow continuous drainage and prevent the liquid from stagnating inside.
Prevention
The most important rule for the prevention of Bartolini's cysts is the maintenance of good genital hygiene : therefore, it is necessary to pay attention to an accurate and daily local cleaning and, especially in summer, to change underwear frequently.
Another good habit to reduce the risk of incurring genital infections is to avoid the abuse of sanitary napkins and panty liners for the whole day, if not necessary. In fact, these hinder the correct skin transpiration. For the same reason, the use of synthetic clothing and tight underwear is not recommended: the continuous rubbing of the fabric on the skin can predispose to local irritations.
Another useful preventive measure for the prevention of Bartolini's cyst is the use of a condom whenever there is a cohort relationship with your partner. Indeed, practicing safe sex can help reduce the chances of developing a cyst infection and the formation of an abscess of Bartholin's glands.
