A Bartholin gland cyst forms when the duct of one of the two small glands beside the vaginal opening becomes blocked and fills with fluid. If the cyst gets infected it turns into a painful abscess that usually needs drainage.
Key symptoms
- Painless lump on one side of the vaginal opening
- Pain when walking, sitting or during sex
- Rapid swelling and severe pain with an abscess
- Fever in some patients with an abscess
What you find on exam
- Round mass at the 4 or 8 o'clock position of the vaginal opening
- Tenderness, redness and warmth with an abscess
- Fluctuance that suggests pus
- Check for spreading cellulitis
Tests
- Diagnosis is usually clinical
- Testing for gonorrhea and chlamydia when at risk
- Culture of drained pus if recurrent or severe
- Biopsy of a solid mass in patients over 40 to rule out cancer
Treatment basics
- Small painless cysts: no treatment or warm sitz baths
- Abscess: incision and drainage with a Word catheter left in place
- Marsupialization for recurrent cysts
- Antibiotics for cellulitis, STI risk or a weak immune system
Red flags
- Fever with spreading redness
- Firm, irregular mass in an older woman
- Recurrent abscesses despite treatment
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.