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A sudden noticeable swelling over the vulva region is always a cause for concern. Furthermore, painful swelling in the vulva region is a particularly concerning symptom that warrants medical evaluation. Often the question arises “Doctor, is this an STD (Sexually Transmitted Disease)?”
Due to the acute presentation and discomfort of a Bartholin’s cyst, people tend to turn up in the consultation room with concerns of possible infection and seeking treatment. In this article, we explore this medical condition, the possible triggers, and how we can manage it.
Over the lining opening of the vulva (external vagina), there are small glands known as the Bartholin’s glands. These glands serve to produce healthy fluid to lubricate your vagina. However, the opening of the gland can develop blockages, leading to the accumulation of fluid in the gland and the formation of a cyst. Bartholin’s cysts are usually painless, but they can be palpable and swollen over the opening of the vagina.
Occasionally, Bartholin’s cysts can become infected with bacteria, leading to a painful abscess that requires medical attention.
Bartholin’s cyst or infection commonly affects women of reproductive age. The incidence decreases once a woman reaches menopausal age. Bartholin’s cyst cases make up approximately 2% of gynaecological cases seen annually.
Bartholin’s cysts generally do not cause symptoms as they tend to be small. However, when it gets infected, one may experience the following:
The actual cause of Bartholin’s gland becoming blocked is still unclear. Bartholin’s cysts tend to occur during reproductive years and become less common after menopause. A Bartholin’s gland can potentially get blocked due to:
It can be useful to evaluate the possible triggers with your trusted healthcare providers. Modifiable triggers, such as lifestyle that irritates the vulva, can be avoided, and infection can be treated to prevent the further occurrence of Bartholin’s cyst.
Risk factors for developing Bartholin’s cysts include:
Although the majority of the cause of Bartholin’s cysts or abscesses remains unknown, there is an association of Bartholin’s cysts/abscesses with sexually transmitted infections (STIs), particularly chlamydia and gonorrhoea. It may be worthwhile to consider screening for bacterial STIs if there is evidence of recurring Bartholin’s cyst infections and if you are sexually active.
Non-STI-related bacteria such as E coli (bacteria from the colon/anorectal region), Streptococcus pneumoniae, and Haemophilus influenza are pathogens that can potentially block the Bartholin’s glands and lead to infection and abscess formation.
If the STI-related bacteria are not treated, Bartholin’s infection may not recover. In the long run, one may risk developing chronic vaginitis, pelvic inflammatory disease (PID), and infertility, and one can spread the infection to one's partner(s). Thankfully, infectious Bartholin’s cysts are treatable with proper antibiotics.
If you are concerned about a Bartholin’s cyst, reach out to your healthcare provider. Your doctor will offer a physical examination involving the vaginal area to look for any abnormal lumps and infections over the area. In certain circumstances where there are concerns of infection, your doctor may offer swab tests to send off fluid discharge samples to the laboratory for further testing.
If the infected Bartholin’s cyst is left untreated, there is a possibility that the cyst may burst spontaneously over time, causing pain and discomfort. Sometimes, the infected cyst may progress and become an abscess (a pocket collection of pus); one can be unwell with fever and vulva pain. In such circumstances, oral treatment may be insufficient, and surgery may be required to manage the symptoms.
Small and painless Bartholin’s cysts do not require treatment. Nonetheless, if the cyst becomes painful and infected, medical treatment is advised.
Treatment for a Bartholin’s cyst usually involves:
Avoid possible triggers such as repeated friction or trauma to the vulva region. If this is a risk factor in your circumstances, consider a regular STI screen. In the case of a mild Bartholin’s cyst without evidence of infection, you can consider a regular Sitz bath method to allow spontaneous resolution of symptoms.
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