Bartholin cyst is a retention formation that forms when the duct of the large gland of the vestibule of the vagina is blocked, stenosis or overgrowth. With small sizes, it does not cause unpleasant sensations. Large cysts can cause a feeling of heaviness when walking, dyspareunia. The addition of infection provokes inflammation, the appearance of pain syndrome. Diagnostics is based on gynecological examination data, ultrasound is used as an additional method to determine the size of the formation, the presence of partitions in it. Surgical treatment – autopsy, excision, marsupialization, chemical destruction.
ICD 10
N75.0 Bartholin cyst
General information
Cysts are the most common pathology of the bartholinium glands. In the structure of the general gynecological morbidity, they are diagnosed in 2-8% of women who have sought medical help. Bartholin cyst is common among sexually active and giving birth to women. The risk of developing pathology increases after childbirth, during which an episiotomy was performed, therefore, cystic lesion of the vestibule gland occurs more often on the right. Small cysts do not require treatment if they do not worsen a woman’s quality of life and do not create discomfort during sex.
Causes
The Bartholin gland is a paired organ located in the thickness of the base of the labia majora. It secretes a protein-rich mucus that moisturizes the mucous membrane of the entrance to the vagina, and during sexual arousal serves as a lubricant. The excretory mouth of the bartholin gland, 1.5-2 cm long, can stenose, clog or bend under the influence of various factors:
- Infection. Vulvitis or vaginitis of a specific and non-specific nature can cause damage to the tissues of the bartholin gland and the development of bartholinitis. With a chronic course, in response to the vital activity of the bacterial flora, the processes of proliferation and formation of connective tissue increase, which leads to the accumulation of secretions and the expansion of the cavity with the formation of a cyst.
- Episiotomy. During childbirth, with the threat of rupture of the perineum, an incision is made to the right for 8 hours – in an area that does not contain large vessels and nerve bundles. Sometimes the duct of the gland is damaged. After tissue healing, its stricture is formed or complete overgrowth occurs.
- Injuries of the perineum. After mechanical damage to tissues, reparative processes can lead to the proliferation of connective tissue, the formation of scars. When the duct of the bartholin gland is involved, it bends and narrows, a cyst forms.
- Non-compliance with hygiene. Blockage of the gland outlet is observed in women who ignore hygiene procedures. Irritation of the perineal tissues occurs when using tight underwear and wearing synthetics. Deep epilation in the bikini area can also cause the appearance of a cyst.
Pathogenesis
The excretory ducts of the bartholin gland open between the labia minora and the hymen or its remnants. At rest, a small amount of mucous secretion is produced that moisturizes the vulva. In an excited state, the secretion increases. During the formation of narrowing, blockage of the duct, the mucous secret accumulates in the bartholin gland, stretches it and forms a cyst. With an increase in the cyst, swelling of the surrounding tissues occurs.
A change of sexual partner, infection with sexually transmitted infections, can lead to the penetration of pathogens into the cystic cavity. An inflammatory process develops, the contents of the gland are suppressed. At the site of cystic formation, a secondary abscess is formed, which is accompanied by a characteristic change in symptoms.
Symptoms
Bartholin cyst is asymptomatic, it is detected accidentally during hygienic procedures. A woman independently palpates a rounded dense painless formation at the base of the labia on one side. A large cyst creates a feeling of discomfort and a foreign object in the perineum, which increases when walking, sitting.
During sexual intercourse, the cyst blocks the entrance to the vagina, so sex is accompanied by painful sensations. After infection, the pain increases, appears during movement and at rest. Relief of the symptom is possible only in the supine position with bent and slightly spread legs. Sometimes the inflammation of the cyst is supplemented by symptoms of vaginitis.
Complications
With an untimely appeal to the gynecologist, the cyst reaches the size of a goose egg. The penetration of infection is the cause of the formation of a secondary abscess, accompanied by a deterioration in the general condition, the appearance of symptoms of intoxication, an increase in body temperature. In the absence of surgical treatment, a spontaneous breakthrough of pus outside or its spread to the perineal tissue is possible.
Diagnostics
The diagnosis is carried out by a gynecologist, in the process of diagnosis, examination data, instrumental and laboratory techniques are used. Differential diagnosis is performed with an infected hematoma in the vulva, inflammation of the paraurethral glands. The following survey methods are used:
- Gynecological examination. At the base of the labia majora, a rounded dense formation without fluctuation is determined on one side. In the absence of an inflammatory process, swelling and redness are not detected. Hyperemia, fluctuation, as well as signs of intoxication indicate in favor of an abscess.
- A smear from the vagina. When combined with colpitis, signs of inflammation are detected. In the smear, the number of leukocytes is increased, the coccal flora predominates, the number of rods is reduced. The changes are non-specific.
- Laboratory diagnostics. In the absence of infection, blood and urine tests are unchanged. With the development of the inflammatory process in the general blood study, an increase in ESR, leukocytosis with a shift to the left is noted.
- Ultrasound of the cyst. Allows you to determine the exact size of the tumor formation, the condition of the surrounding tissues. Sometimes cavities are visualized in the cyst, the presence of which must be taken into account during surgical treatment.
Treatment
Medicinal methods are ineffective because they do not allow to eliminate the main cause of pathology – violation of the outflow of secretions. When signs of inflammation appear, broad-spectrum antibiotics are prescribed, which help reduce swelling and reduce the likelihood of infectious complications in the postoperative period. The main treatment is carried out by surgical methods in the department of gynecology.
- Opening and drainage of the cyst. Under local anesthesia, an incision is made in the place of the greatest protrusion. The contents are removed, the cavity is washed with an antiseptic solution, a rubber drainage is installed. After such treatment, a relapse often occurs.
- Marsupialization of the cyst. The method allows you to save the bartholin gland. After opening and emptying the cyst, a new duct forms from the edges of the capsule. The results can be judged in 3-5 weeks. There is a risk of obliteration of the hole and recurrence of the cyst.
- Cyst removal. During the operation, a cyst with a capsule and a bartholin gland is exfoliated. The bed is carefully sutured. This is a radical treatment, after extirpation of the cyst, the risk of recurrence is completely eliminated.
- Installing a WORD catheter. The operation is similar to marsupialization. After cleansing the cyst, a WORD catheter is inserted into it, which is a rubber tube with a balloon at the end. It is pumped with air and squeezed. The catheter is retained for up to 6 weeks until the new duct is epithelized. The risk of relapse reaches 10%.
- Destructive methods. With the help of a laser, you can open a cyst, vaporize its capsule. Silver nitrate, 70% alcohol solution have a destructive and sclerosing effect. At the same time, ethanol often gives complications in the form of tissue necrosis, scar deformation, therefore it is not recommended for destruction.
Prognosis and prevention
With timely access to a doctor, the prognosis for cystic formations of the bartholin gland is favorable. The results of treatment are improved if the operation is performed at rest, in the absence of inflammation or abscess. To prevent the formation of a cyst, it is necessary to avoid accidental sexual contact, observe the rules of personal hygiene, and treat vaginitis, vulvitis, and bartholinitis in a timely manner. It is not recommended to use tight underwear made of synthetic fabrics.
