The Bartholin glands are small, pea-sized structures located on each side of the vaginal opening. These glands play a role in female anatomy by producing a lubricating fluid that helps maintain moisture in the vaginal area. A Bartholin cyst forms when the duct, or tube, that drains fluid from one of these glands becomes blocked, leading to a buildup of fluid and swelling.
Understanding Bartholin Cysts
The Bartholin glands, also known as the greater vestibular glands, are situated within the labia minora at the 4 and 8 o’clock positions relative to the vaginal opening. Each gland has a duct that opens onto the vestibule, releasing a mucous secretion that aids in vaginal lubrication.
The blockage that causes a Bartholin cyst can result from various factors, including inflammation, infection, or even minor injury. These cysts typically present as a firm, round lump near the vaginal opening, ranging in size from a pea to a golf ball. They are generally benign and often cause no symptoms, though larger cysts might cause mild irritation or discomfort. Bartholin cysts are common, affecting about 2% of women at some point in their lives, most frequently occurring during childbearing years.
Bartholin Cysts and Cancer Risk
Bartholin cysts themselves are almost always benign and do not cause cancer, as they are noncancerous fluid-filled sacs resulting from duct blockage. However, it is important to understand the rare distinction between a benign cyst and a primary malignancy originating within the Bartholin gland tissue.
Cancer of the Bartholin gland is exceedingly rare, accounting for less than 1% of all vulvar cancers and a very small fraction of all female genital tract malignancies. When such a malignancy does occur, it typically arises directly from the gland’s cells, often as an adenocarcinoma or squamous cell carcinoma, rather than developing from a pre-existing cyst. These rare cancers are more commonly observed in postmenopausal individuals, with a median age of diagnosis around 53 to 60 years.
A key difference is that while a benign cyst is usually soft and mobile, a cancerous mass in the Bartholin gland may feel firm, fixed to surrounding tissues, and can persist without responding to typical treatments. While a Bartholin cyst itself is not a precursor to cancer, any suspicious features, particularly in older individuals, warrant thorough investigation to rule out this extremely rare condition. The presence of a Bartholin mass in a postmenopausal woman is often considered suspicious until proven otherwise.
Recognizing Symptoms and Seeking Medical Advice
Many Bartholin cysts are small and may not produce any noticeable symptoms. When symptoms do occur, they typically involve a soft lump near the vaginal opening, which might cause discomfort or pain, especially during activities like sitting, walking, or sexual intercourse. If the cyst becomes infected, it can develop into a painful abscess, leading to additional symptoms such as redness, tenderness, swelling, and sometimes fever.
It is advisable to seek medical attention if a lump near the vaginal opening is painful, rapidly grows, or does not improve with self-care measures like warm sitz baths within a few days. For individuals over 40 years old, or those who are postmenopausal, it is particularly important to have any new lump or mass in the Bartholin gland area evaluated by a healthcare provider. While rare, certain signs such as a firm or fixed mass, unusual appearance, or persistent growth, especially in older women, may indicate a need for further investigation to exclude malignancy.
Diagnosis and Management Approaches
Healthcare providers typically diagnose a Bartholin cyst through a physical examination, assessing the size, consistency, and location of the lump. In some cases, a sample of vaginal secretions may be taken to test for infections, including sexually transmitted infections, if suspected.
Management approaches for Bartholin cysts vary depending on their size and whether they are causing symptoms or are infected. Small, asymptomatic cysts often do not require treatment and may resolve on their own with conservative measures such as warm sitz baths. For symptomatic or infected cysts that have formed an abscess, medical interventions may be necessary. These can include surgical drainage of the cyst, a procedure called marsupialization where a permanent opening is created to allow drainage, or, in rare instances, complete removal of the gland.
In situations where there is suspicion of malignancy, such as in older individuals or if the mass has atypical characteristics like firmness or fixation, a biopsy is the definitive diagnostic tool. A biopsy involves taking a small tissue sample from the mass for microscopic examination to rule out cancerous cells.