Overview

• Benign lesion of the vulva.
  • Develops when the entrance to the Bartholin duct becomes blocked. The gland continues to produce mucus which builds up behind the blockage, eventually leading to the formation of a mass.
  • Located lateral and inferior to the vaginal opening.
• Risk Factors → nulliparous, previous bartholin’s cyst, sexually active.

Making Diagnosis

Clinical Features

• Unilateral labial swelling, often asymptomatic/painless.
  • Infected (Abscess - typicall e.coli) → abscess, fever, dyspareunia, pain on sitting/walking.
• Usually 1-3cm in diameter.
• Cyst is characterised by the presence of a soft, painless lump in the labium.

Investigations

• Clinical Diagnosis.
• If ≥40 years old → consider vulval biopsy.
• If Infected → MC&S from abscess.

Management Plan

• Asymptomatic (Smaller) Cyst ⇒
  • Conservative Approach → sitz bath + warm compression + simple analgesia.
• Symptomatic (Larger) Cyst ⇒
  • Word Catheter Drainage → done under local anaesthetic. Stays in place for 4-6 weeks.
  • Marsupialisation → surgery to drain the cyst. Under general anaesthetic.
• Abscess ⇒
  • Marsupialisation and Broad-Spectrum Antibiotics (ceftriaxone, doxycycline, azithromycin).