INTRODUCTION

The Bartholin’s cysts are the fluid-filled sac which automatically develops inside the opening of the vagina. These cysts are generally benign and usually feels like small painless lumps, which are soft when they are touched. These are formed around the area of Bartholin’s glands. The Bartholin’s glands are a pair of small-sized racemose glands present in the right and left side of the opening of the vagina. Bartholin’s glands help secrete mucus for the lubrication of the vagina. The fluid secreted by these glands slightly moisten the opening of the vagina to make contact with this area more comfortable.

The Bartholin’s glands can become inflamed and blocked which signs towards the development of cysts in the opening of the vagina. When the Bartholin’s cyst inflames then this condition is called as bartholinitis. The cyst may become infected, and an abscess may develop in the gland. This infected cyst turns out in an intense red colour and feels painful and hot, which can also lead to a high temperature of 38 degrees C and above.

However, if these cysts grow in size, then they might become noticeable and uncomfortable. People feel pain inside the skin around the vagina (vulva) while they walk, sit down or during sexual intercourse. These cysts can sometimes affect the outer region of the area surrounding the vagina (labia majora). As a result, one side of the vagina may look bigger or swollen than the other side. Sometimes home remedies can treat Bartholin’s cysts but in some cases, surgery is required.

WHO SHOULD UNDERGO THIS SURGERY

Women with the symptoms of Bartholin’s cysts or abscesses are advised to undergo an excision procedure to get relief from the symptoms of Bartholin’s cysts. When the surgery is performed systematically, then the procedure can treat the condition and prevent the reoccurrences of such issues in the future.

The severity of the symptoms are the major factors on which the treatment of Bartholin’s cysts typically depends. A number of patients do not experience any symptoms related to this treatment which means that surgery is not required in such cases. While, surgical intervention is only recommended when the Bartholin’s cysts are causing serious problems which include pain at the time of performing daily life activities such as walking, sitting or during intercourse.

Before undergoing surgery, an obstetric-gynecologist (OB-GYNE) will clean the area to examine the discharge from the vagina and if needed, he will recommend a biopsy to study whether he can safely excise the cysts or the symptoms are indicating towards a more serious problem. It could be anything like vulval cancer. The doctor usually recommends an excision only when the abscesses develops. 

Women are advised to see the doctor if they have developed a painful lump near the vaginal opening which is not healing even after a self-care (soaking the area where cysts have been developed with warm water) of three to four days and the pain is getting severe. Also, those women who have crossed 40 and have developed a new lump near their opening of the vagina should contact the doctor as soon as possible as it might be due to some serious problems.

SYMPTOMS AND CAUSES
If women have developed a small non-infectious Bartholin’s cyst, they might not notice it. If the cysts grow at the opening of the vagina, a lump or mass near the vaginal opening is felt. Although a cyst is generally painless it can become painful. A fully grown infection of the Bartholin’s cysts can also occur in a matter of days. If the cysts become infected then women may experience a painful lump near the opening of the vagina and discomfort at the time of sitting and walking, painful sexual intercourse, chills, and fever. The Bartholin’s cysts and abscess usually occur at only one side of the opening of the vagina.

The Bartholin’s glands are a pea-sized pair of glands present right behind and each side of the area that surround the opening of the vagina. These glands are generally not noticeable because they are rarely more than 1cm. The Bartholin’s glands are known for the secretion of fluid which acts as a lubricant during intercourse. The fluid secreted by these glands travels down through the tiny tubes known as ducts into the vagina. The cyst can range from the size of a pea to the size of a golf ball.

It is believed by the experts that the cause behind the Bartholin’s cyst is the backup of fluid. The Bartholin’s cysts become infected after the formation of an abscess. If the ducts get blocked then they get filled with this fluid and develop in the form of a cyst. The reason behind why the ducts become blocked is often not known but in some cases, the reason is linked to STIs sexually transmitted bacterial infections which are gonorrhea, chlamydia, streptococcus pneumonia. Other bacterial infections like Escherichia coli which affects the water supply, is also one of the reasons in some cases.

Women are more likely to develop Bartholin’s cysts when they are:

– Sexually active and young
– Have become pregnant only once.
– Have not become pregnant yet.
– In their 20s and 30s.

* The Bartholin’s cysts do not affect children as these glands don’t start functioning until puberty and these cysts are also not common after the menopausal period as the Bartholin glands shrink after menopause.

TREATMENT

If women don’t have any symptoms which are noticeable, it is not likely to have a treatment but the women will be asked for a time to time report about any growth in the size of the cysts. If the cysts are painful, then the doctor may recommend some common and simple treatments to be done at home such as soaking the cysts in warm water for three to four days several times a day and taking painkillers prescribed by a doctor. If these home remedies do not work, then other more treatments are available to cure the pain and any infections. And if the doctor finds it necessary, then he can drain out the cyst. Most of the treatments include some minor surgeries. But sometimes the Bartholin’s cysts return after treatment. If a woman has already got into the menopausal period and find any lump near the vaginal area, then it should be reported to the doctor. In the minor surgery, the doctor will insert a surgical instrument called a catheter into the cyst. Other treatments involve:

MARSUPIALIZATION
In this process, the surgeon makes a cut in the cyst so that the fluid can drain out. After that, the surgeon stitches the edges of the skin while leaving some parts open only for the secretion.

CARBON DIOXIDE LASER
This process is used to create an opening which can help to drain out the cyst.

NEEDLE ASPIRATION
A needle is used in this procedure to drain the cyst. After this process of draining the cyst, the empty place is then filled with an alcohol liquid solution of 70 percent to reduce the chances of infection.

GLAND EXCISION
In some of the cases, the cysts kept re-occurring and not respond to any of the treatments, then the doctor might recommend for the removal of the Bartholin gland.

THE BALLOON CATHETER TECHNIQUE

This technique is also referred to as fistulization and catheter placement. In this, the surgeon drains out the fluid or mucus present inside a Bartholin’s cyst. The woman is first given local anesthesia. Some women may also opt for general anesthesia. After that, the surgeon makes a cut in the cyst or in an abscess to drain the fluid out. When the cyst is empty, then the surgeon will insert a surgical instrument catheter along with an inflatable balloon at one of the ends. The surgeon fills the balloon with a saline solution.

The surgeon will suture the incision partially by leaving enough opening for the catheter. After that, the surgeon will leave the catheter in the place to heal the wound. In the process known as ‘epithelialization,’ new cells will be grown near the catheter. After this process of epithelialization, the surgeon will drain out the balloon and the catheter will be removed.

MARSUPIALIZATION

The technique of marsupialization is commonly recommended to women suffering from the problem of recurring cysts and abscesses. The first and foremost the patient will be given general anesthesia. After that, the surgeon will make a cut in the cyst so that all the fluid can drain out. The surgeon will then make stitches on the edges of the skin near the abscess or cyst by creating a little pouch. Due to this pouch, additional fluid and further draining will be facilitated. Now the surgeon will close this area by a sterile dressing, which will soak up the fluid left inside and stop the bleeding. Both the techniques are performed on an outpatient basis and the patient is discharged immediately after the anesthesia wears off.

Consult your doctor to know more about the treatment option best suited for your condition. These kinds of surgeries should be performed under the supervision of an expert surgeon, doctor, and consultants. Apollo Cradle Jayanagar is a place where they have a well-trained team of competent and experienced doctors, surgeons, nurses and technicians with high success rates.