Bartholin's cyst

On either side of the vaginal opening, within the outer lips, lie two small glands. Their ducts open outwards and release fluid that keeps the tissue moist. If a duct becomes blocked, the fluid stays inside and the gland swells: that is a cyst. It is one of the commonest lumps in this area, harmless in itself and often resolving without any intervention at all. Two circumstances nevertheless make a medical review essential: the cyst can become infected, and very occasionally a quite different condition hides behind a similar-looking lump.

What you notice

A cyst is usually found by chance, felt while washing or when underwear starts to rub. It is soft and mobile, sits on one side, closer to the lower edge of the vaginal opening. The size can be anything from a pea to a large plum. A small cyst causes no symptoms whatsoever.

As it grows, you may notice:

• a sense of something being there, of fullness or heaviness on one side;
• a visible difference between the outer lips, with one looking larger and pushed outwards;
• discomfort when walking, cycling or sitting for a long time;
• pain or discomfort during sex.

Most of those affected are women of reproductive age, roughly from twenty to the early forties. After the menopause the glands become less active and cysts appear noticeably less often.

When the cyst becomes infected

If bacteria get into a blocked gland, the contents turn to pus and an abscess forms. The difference from a quiet cyst is obvious: within a matter of hours, or a day or two, a settled lump changes character.

• the pain becomes sharp and throbbing and makes walking and sitting difficult;
• the skin over the lump stretches tight and turns hot and red, though redness is harder to see on brown and black skin, so go by the heat and the swelling;
• the lump enlarges quickly and feels tense;
• a temperature develops, along with shivering and a general sense of being unwell;
• sometimes the abscess bursts by itself and foul-smelling pus comes out.

An abscess does not settle by itself and does not wait: it needs to be opened and drained, usually the same day. Seek urgent care, and if there is a high fever with shivering, spreading redness, marked weakness or dizziness, call the emergency number 112, because that is how a spreading infection requiring hospital treatment can begin.

A lump that must not go unexamined

Several other things look much the same: a sebaceous cyst, a lipoma, an inflamed hair follicle, a hernia, genital warts, or blisters of herpes. One rare but serious cause deserves separate mention: cancer of the vulva. It is uncommon and almost always occurs after fifty or sixty, yet at an early stage it too can look like an innocent little lump beside the vaginal opening.

Hence a practical rule: in women over forty, and whenever a lump fails to settle, keeps growing, has become hard and fixed, has ulcerated or bleeds, the doctor takes a small piece of tissue for examination. This is not a sign that the worst is suspected but an ordinary precaution, and the only way to tell one thing from another with certainty. For the same reason any new lump in this area is worth showing to a doctor, even if it does not hurt in the least.

What you can do at home

While the cyst is small and not infected, the aim is simply to help the duct open and to ease the discomfort.

• Sit in a warm shallow bath three or four times a day for about a quarter of an hour, for several days running. Warmth often lets the contents drain on their own.
• Use a warm damp compress if a bath is impractical.
• Take an over-the-counter painkiller if the pain is bothersome; if you have an allergy to such medicines or stomach trouble, ask a pharmacist first.
• Wear loose cotton underwear and keep perfumed gels and sprays away from the area.

What must not be done is squeezing, pricking with a needle, or trying to open or pick at the cyst yourself. That introduces bacteria and turns a harmless cyst into an abscess. If the cyst bursts on its own, that is a good outcome and the pain eases at once. Rinse the area with warm water, keep it clean and dry, and let it heal.

How a doctor treats it

An examination is usually enough to establish what is going on. You are entitled to ask for a third person to be present during the examination, whether a nurse or someone you have brought with you. Fluid from an abscess is sent for culture, and where there is reason to, tests for sexually transmitted infections are offered: gonorrhoea and chlamydia can play a part in the infection, although ordinary skin and bowel bacteria are more often responsible.

A quiet cyst causing no trouble needs no treatment and is simply kept under observation. When it is large, painful or infected, it is drained. A simple needle drainage helps only briefly, as the cavity closes and refills. The procedures used therefore aim to keep an opening: a thin catheter with a small inflatable balloon is passed through a tiny incision and left in place for several weeks until the edges heal into a permanent channel. The alternative is marsupialisation, in which the edges of the incision are stitched to the skin to form a new duct opening. Both are done under local anaesthetic, less often under a general one. Antibiotics are not always required; they are needed when the surrounding tissue is clearly inflamed, when there is fever, in pregnancy or with a weakened immune system, but they are no substitute for drainage.

Cysts come back in roughly one woman in ten. Where they recur stubbornly, removing the gland altogether is discussed, though this operation is kept as a last resort because it is more difficult and involves bleeding.

Online consultation: how it helps

A remote appointment makes sense when a lump has just appeared and you cannot tell whether it is worrying or not. The doctor will go through how and when it came up and what it feels like, explain what to expect and which home measures are worth trying. Online is also convenient for what comes afterwards: how to care for the area once the cyst has been drained, what to do if it returns, whether tests for infection are needed, whether surgery should be on the table. Even so, any new lump must eventually be examined in person, since it cannot be felt at a distance. And with rapidly worsening pain, pus and fever, you need to be seen today rather than to write about it.

This material is for information only and does not replace medical advice.