A Bartholin cyst is caused by the blockage of the Bartholin gland duct, leading to the accumulation of secretions. After the acute inflammation subsides, the gland duct becomes obstructed, preventing the discharge of secretions. The pus gradually turns into clear fluid, forming a cyst. Sometimes, the mucus within the gland cavity becomes thick, or congenital narrowing of the gland duct hinders fluid drainage, which can also lead to cyst formation. If secondary infection occurs, it may result in recurrent abscesses.

bubble_chart Etiology

After the inflammation subsides, the pus in Bartholin's glanditis is absorbed and may be replaced by mucus, forming a Bartholin's gland cyst. The disease is caused by the obstruction of the Bartholin's gland duct due to nonspecific inflammation; a few cases are due to the gland duct being severed during a lateral episiotomy in childbirth; or severe scar tissue resulting from vaginal or lateral perineal lacerations during childbirth. Some Bartholin's gland cysts may remain asymptomatic for a long period, grow slowly, and are suddenly discovered later, making it difficult to understand their origin.

bubble_chart Clinical Manifestations

Bartholin's gland cysts are located at the site of the Bartholin's gland in the posterior part of the labia, usually unilateral, with variable size, generally not exceeding the size of an egg, and prominently bulging on the outer side of the labia majora. Sometimes the cyst is limited to a part of the gland. Cysts of the superficial duct are more common than those of the deeper gland. If the duct is not obstructed, the size of the cyst can often vary. The epithelium of the cyst wall is diverse, ranging from transitional epithelium to simple cuboidal or squamous epithelium, and sometimes there is no epithelium at all, only chronic inflammatory connective tissue. The contents of the cyst are clear mucus, rarely serous, and sometimes mixed with blood, appearing red or brownish-red, which can be easily mistaken for an endometrial cyst, especially when the cyst wall is lined with epithelium containing pseudoxanthoma cells, making it even more confusing.

The diagnosis can be easily made based on the location and appearance of the cyst, and the absence of inflammation upon local palpation. If necessary, a local puncture can be performed to differentiate its contents from those of an abscess. The entire excised cyst can then be subjected to pathological examination to confirm the diagnosis.

bubble_chart Treatment Measures

Since cysts can become secondarily infected, surgical treatment should be pursued. In the past, cystectomy was commonly performed, but it often carried the risk of bleeding. If the cyst wall extends near the urethra, the surgical procedure becomes difficult, or the cyst wall may not be completely removed, leading to the possibility of recurrence. Severe scarring can result in dyspareunia, so currently, cystectomy is only applied to cases suspected of malignant transformation. Cystostomy (marsupialization), through years of practice, has proven to be a simple, safe method with fewer complications, a low recurrence rate, and the ability to preserve gland function. It can also be applied to abscesses of the Bartholin's gland.

bubble_chart Differentiation

Attention should be paid to differentiating from labia majora inguinal hernia, which is associated with a pulsating sensation in the inguinal mass. The mass slightly enlarges when bearing down, and percussion produces a tympanic sound. It usually appears suddenly after excessive exertion. Based on these characteristics, differentiation is generally not difficult.