Bartholin Cyst: Symptoms, Causes & Treatment Options

What Is a Bartholin Cyst?

A Bartholin cyst is a fluid-filled sac that forms when the duct of a Bartholin gland becomes blocked. The Bartholin glands are two small, pea-sized glands located on each side of the vaginal opening that produce mucus to help lubricate the vagina. When the duct is blocked, fluid backs up and forms a cyst that can range from painless to extremely painful if infected.

The Bartholin glands, named after Danish anatomist Caspar Bartholin who first described them in the 17th century, play an important role in vaginal lubrication. Each gland is connected to the vaginal opening by a small duct approximately 2.5 centimeters long. These ducts normally allow the lubricating fluid produced by the glands to reach the vaginal opening, providing moisture during sexual arousal and maintaining tissue health.

When one of these ducts becomes blocked, the fluid produced by the gland has nowhere to go. Instead of draining normally, it accumulates within the gland, causing it to swell and form a cyst. This blockage can occur for various reasons, including thick mucus that clogs the duct, minor trauma to the area, or changes in the tissue that narrow the duct opening. The resulting cyst is typically filled with clear or slightly cloudy fluid and can range in size from barely noticeable to several centimeters in diameter.

Understanding the difference between a Bartholin cyst and a Bartholin abscess is clinically important. A cyst contains fluid and may or may not cause symptoms depending on its size. An abscess occurs when bacteria infect the cyst, causing it to fill with pus. Abscesses are typically much more painful than simple cysts and often require more aggressive treatment. The bacteria involved in abscess formation can include common skin bacteria like Staphylococcus aureus, intestinal bacteria like Escherichia coli, or sometimes sexually transmitted organisms.

Anatomy of the Bartholin Glands

The Bartholin glands are located at approximately the 4 o'clock and 8 o'clock positions of the vaginal opening, deep within the tissue of the labia majora. Each gland is about the size of a pea in its normal state and is not typically palpable during a routine examination. The glands produce a small amount of mucoid secretion that helps maintain vaginal moisture and provides additional lubrication during sexual activity.

The duct of each gland opens just outside the hymenal ring, near the junction of the middle and posterior thirds of the labia minora. This anatomical location makes the duct vulnerable to trauma, infection, and obstruction. When examining a patient with a suspected Bartholin cyst, clinicians will find the swelling at the posterior aspect of the labia majora, typically creating an asymmetric appearance of the vulva.

Who Gets Bartholin Cysts?

Bartholin cysts occur most frequently in women of reproductive age, particularly those between 20 and 30 years old. This age distribution likely reflects the increased glandular activity during the reproductive years. The condition rarely affects prepubertal girls or postmenopausal women, though it can occur at any age. Research suggests that approximately 2% of women will develop a Bartholin cyst or abscess at some point during their lifetime, making it one of the more common gynecological conditions seen in outpatient settings.

What Are the Symptoms of a Bartholin Cyst?

Symptoms of a Bartholin cyst include a soft, painless or painful lump near the vaginal opening on one side, discomfort when sitting, walking, or during intercourse, and visible swelling of the labia. If the cyst becomes infected and forms an abscess, symptoms include severe pain, redness, warmth, tenderness, and possibly fever.

The symptoms of a Bartholin cyst depend largely on its size and whether infection has developed. Many small cysts cause no symptoms whatsoever and may be discovered incidentally during a routine gynecological examination. Women with small, asymptomatic cysts may not even be aware they have one, and these cysts may come and go without ever requiring treatment.

As a cyst grows larger, it becomes more noticeable and may begin to cause physical discomfort. The swelling typically develops gradually over days to weeks, though some women notice more rapid enlargement. The cyst usually appears as a round, smooth mass at the posterior aspect of one of the labia majora. Because the Bartholin glands are paired structures, cysts almost always occur on only one side at a time, creating an asymmetric appearance of the vulva.

Physical activities that put pressure on the vulvar area tend to exacerbate symptoms. Women with larger cysts often report discomfort when sitting, especially on hard surfaces, and may find it uncomfortable to walk or exercise. Sexual intercourse can become painful or impossible when a significant cyst is present, as the penetration and friction involved can put direct pressure on the swollen gland.

Symptoms of an Uncomplicated Cyst

An uncomplicated Bartholin cyst—one that has not become infected—may present with the following symptoms:

• Soft, round lump: A smooth, movable mass near the vaginal opening that feels like a small grape or marble
• Painless or mildly tender: Simple cysts typically cause little to no pain when touched
• Normal skin appearance: The overlying skin usually appears normal in color without redness or warmth
• Gradual development: The swelling typically develops slowly over time
• Size variation: Can range from pea-sized to golf ball-sized (1-4 cm in diameter)

Symptoms of an Infected Cyst (Abscess)

When bacteria infect a Bartholin cyst, it transforms into an abscess with dramatically different symptoms. This infection can develop rapidly, sometimes over just 2-4 days. The symptoms of a Bartholin abscess include:

• Severe pain: Intense, throbbing pain that may make sitting or walking extremely difficult
• Rapid swelling: The mass may enlarge quickly over hours to days
• Redness and warmth: The overlying skin becomes red, hot, and inflamed (erythema may be less visible on darker skin tones)
• Tenderness: Even light touch causes significant pain
• Fever: Body temperature may rise above 38°C (100.4°F)
• Difficulty walking: The pain may cause a characteristic waddling gait
• Pus discharge: If the abscess begins to drain spontaneously, thick yellow-green pus may be observed

What Causes a Bartholin Cyst?

Bartholin cysts are caused when the duct leading from the Bartholin gland becomes blocked, trapping the lubricating fluid inside. The exact cause of duct blockage is often unknown but may involve thick mucus, minor trauma, or infection. If bacteria enter a blocked cyst, it becomes infected and forms a painful abscess.

The fundamental cause of a Bartholin cyst is obstruction of the gland's duct. Under normal circumstances, the Bartholin glands continuously produce small amounts of mucoid secretion that flows through the duct and exits near the vaginal opening. When this duct becomes blocked, the secretion has no way to escape and accumulates within the gland, causing it to enlarge progressively.

Despite extensive research, the precise mechanism of duct obstruction remains incompletely understood in most cases. The duct opening is quite small—approximately 2-3 millimeters in diameter—which makes it vulnerable to blockage from various factors. Thick or viscous secretions may fail to flow through the narrow duct. Minor trauma to the vulvar area, such as from sexual intercourse, childbirth, or even tight clothing, might cause localized swelling or inflammation that narrows or closes the duct opening.

Previous infection or inflammation in the area can cause scarring that affects duct patency. Even subclinical infections that cause no obvious symptoms might leave behind enough scar tissue to predispose to future duct obstruction. This may explain why some women experience recurrent Bartholin cysts despite appropriate treatment.

Causes of Bartholin Abscess

When bacteria colonize a pre-existing cyst, the result is a Bartholin abscess. The closed environment of a blocked gland provides an ideal medium for bacterial growth, with warmth, moisture, and accumulated secretions creating favorable conditions. Common bacteria that cause Bartholin abscesses include:

• Escherichia coli (E. coli): This intestinal bacterium is the most commonly identified cause of Bartholin abscesses, reflecting the proximity of the vulvar area to the anus
• Staphylococcus aureus: This common skin bacterium, including methicillin-resistant strains (MRSA), can cause severe abscesses
• Streptococcus species: Various streptococcal bacteria found on skin and mucous membranes
• Sexually transmitted organisms: Neisseria gonorrhoeae (gonorrhea) and Chlamydia trachomatis have been found in some Bartholin abscesses, though they are less common causes than previously believed
• Mixed flora: Many abscesses contain multiple bacterial species growing together

It's important to understand that while sexually transmitted infections (STIs) can occasionally cause Bartholin abscesses, the majority of cases involve common environmental bacteria. Studies examining the bacteriology of Bartholin abscesses have found that gonococcal and chlamydial infections account for less than 5-10% of cases in most populations.

Risk Factors

While Bartholin cysts can occur in any woman, certain factors may increase the likelihood of developing this condition. Women in their 20s and 30s are at highest risk, likely due to increased glandular activity during peak reproductive years. Other potential risk factors include:

• History of previous Bartholin cyst or abscess
• Vulvar trauma (from intercourse, childbirth, or other causes)
• Previous vulvar surgery or episiotomy

When Should You See a Doctor for a Bartholin Cyst?

See a doctor if you have painful swelling near the vaginal opening that doesn't improve after a few days of home treatment, if you develop fever along with the swelling, if pain is severe enough to interfere with normal activities, or if you are over 40 years old with any new vulvar mass. Seek immediate care for severe pain with high fever or rapidly spreading redness.

Not every Bartholin cyst requires medical attention. Small, painless cysts may resolve spontaneously or with simple home measures like sitz baths. However, certain symptoms and circumstances warrant professional evaluation and treatment.

A healthcare provider should examine you if the cyst causes significant discomfort that doesn't improve with warm soaks over several days. Pain that prevents you from sitting comfortably, walking normally, or engaging in daily activities indicates that the cyst may be too large to resolve on its own or may have become infected. Similarly, if you notice the swelling increasing in size despite home treatment, medical evaluation is advisable.

The presence of fever along with vulvar swelling is an important warning sign that should prompt you to seek care more urgently. Fever suggests that infection has developed and may be spreading beyond the local area. Systemic symptoms like chills, body aches, or feeling generally unwell can accompany a severe abscess and indicate the need for antibiotic treatment in addition to drainage.

Contact Your Healthcare Provider If:

• Swelling near the vaginal opening doesn't improve after 2-3 days of sitz baths
• Pain makes sitting, walking, or daily activities difficult
• The affected area becomes increasingly red, warm, or tender
• You develop fever (temperature above 38°C or 100.4°F)
• You notice pus draining from the area
• This is a recurrent problem (second or subsequent episode)

Special Consideration: Women Over 40

If you are over 40 years old and develop a new mass in the vulvar area, it's particularly important to have it evaluated by a healthcare provider. While Bartholin cysts can certainly occur at any age, the incidence of Bartholin gland carcinoma—a rare but serious cancer—increases after age 40. Your doctor may recommend a biopsy to examine the tissue and rule out malignancy, especially if the mass has unusual characteristics or doesn't respond to standard treatment.

How Is a Bartholin Cyst Diagnosed?

Bartholin cysts are typically diagnosed through physical examination alone. A healthcare provider will visually inspect and gently palpate the vulvar area to feel the cyst's size, location, and consistency. Additional tests like cultures or biopsy may be performed if infection is present or if cancer needs to be ruled out in women over 40.

The diagnosis of a Bartholin cyst is primarily clinical, meaning it's based on the patient's history and physical examination findings rather than laboratory tests or imaging studies. An experienced clinician can usually diagnose a Bartholin cyst confidently based on the characteristic location and appearance of the swelling.

During the examination, you'll be asked to describe your symptoms, including when you first noticed the swelling, whether it has changed in size, and what symptoms it causes. Your healthcare provider will want to know about any associated symptoms like pain, fever, or discharge. Information about previous episodes, sexual history, and any relevant medical conditions helps guide the evaluation and treatment plan.

The physical examination is performed with the patient lying on an examination table, often with feet in stirrups similar to a routine gynecological exam. The provider will visually inspect the vulvar area, looking for asymmetry, swelling, redness, or other abnormalities. They will then gently palpate (feel) the area to assess the size, consistency, and tenderness of the mass.

What the Examination Reveals

A typical Bartholin cyst appears as a round, smooth mass located at the posterior aspect of the labia majora, at approximately the 5 or 7 o'clock position when viewing the vulva. The characteristics of the mass help distinguish between a simple cyst and an abscess:

Additional Tests

In most cases of straightforward Bartholin cyst or abscess, additional testing beyond the physical examination is unnecessary. However, certain situations may warrant further evaluation:

• Culture and sensitivity: If an abscess is drained, a sample of the pus may be sent for bacterial culture to identify the causative organism and determine which antibiotics would be effective
• STI testing: Screening for gonorrhea and chlamydia may be appropriate for sexually active women, particularly those with multiple partners or other risk factors
• Biopsy: For women over 40 or when the mass has atypical features, a tissue sample may be obtained to rule out Bartholin gland carcinoma or other malignancies

How Is a Bartholin Cyst Treated?

Treatment depends on the cyst's size and whether infection is present. Small, painless cysts may need no treatment. Sitz baths can help small cysts drain naturally. Larger cysts or abscesses require drainage by a healthcare provider, often with placement of a Word catheter that stays in place for 3-4 weeks to prevent recurrence. Antibiotics may be prescribed for infected abscesses.

The approach to treating a Bartholin cyst depends on several factors: the size of the cyst, the presence or absence of infection, the severity of symptoms, and the patient's history of previous episodes. Treatment options range from simple observation and home measures to surgical procedures performed in a hospital setting.

Understanding that not every Bartholin cyst requires intervention is important. Small, asymptomatic cysts discovered incidentally during a routine examination often need no treatment at all. These cysts may remain stable in size, fluctuate naturally with hormonal changes, or resolve spontaneously. A watchful waiting approach is appropriate for small cysts that cause no symptoms.

Home Treatment with Sitz Baths

For small cysts that cause mild symptoms, warm sitz baths represent the first-line treatment. This simple, non-invasive approach can help a cyst drain naturally by softening the tissue around the blocked duct and promoting fluid drainage. To perform a sitz bath:

1. Prepare the bath: Fill a bathtub with several inches of warm (not hot) water, or use a plastic sitz bath basin that fits over the toilet seat
2. Add nothing to the water: Plain warm water is sufficient; soaps, bath oils, or other additives may irritate sensitive tissues
3. Soak for 10-15 minutes: Sit in the warm water, allowing it to cover the affected area
4. Repeat frequently: Perform sitz baths 3-4 times daily for several days
5. Pat dry gently: After each bath, gently pat the area dry with a clean, soft towel

Sitz baths may help approximately 15-20% of small cysts resolve without further treatment. If the cyst doesn't improve after a week of consistent sitz baths, or if it enlarges or becomes more painful, medical treatment is needed.

Incision and Drainage with Word Catheter

For larger cysts or abscesses, the standard treatment involves incision and drainage (I&D) with placement of a Word catheter. This outpatient procedure provides immediate relief while creating conditions for a permanent drainage pathway to form. The Word catheter is a small, inflatable rubber catheter specifically designed for this purpose.

The procedure is typically performed under local anesthesia in a gynecology clinic or emergency department. After numbing the area with a local anesthetic injection, the healthcare provider makes a small incision (approximately 5 millimeters) on the inner surface of the labium, near the normal duct opening. The cyst contents are drained, and the cavity may be irrigated with saline solution.

A Word catheter is then inserted through the incision. The catheter has a small balloon at one end that is inflated with 2-3 milliliters of saline to hold it in place inside the cyst cavity. The free end of the catheter remains outside the body. The catheter must remain in place for 3-4 weeks to allow the tract to epithelialize (become lined with skin cells), creating a permanent new opening for the gland to drain through.

Care After Catheter Placement

Living with a Word catheter in place requires some adjustments but should not significantly interfere with daily activities. Here's what to expect:

• Showering and toileting: You can shower and use the toilet normally. Pat the area dry gently after bathing
• Mild discomfort: Some women experience a sensation of pressure or mild discomfort, especially when sitting. The catheter can sometimes be gently tucked into the vaginal opening for comfort
• Activity restrictions: Avoid sexual intercourse, tampons, and bathing (submersion in water) while the catheter is in place
• Watch for complications: Contact your healthcare provider if the catheter falls out prematurely, if you develop fever, or if pain significantly worsens
• Catheter removal: After 3-4 weeks, the catheter is removed either by the patient at home (after instruction) or by the healthcare provider

Marsupialization

For recurrent Bartholin cysts or when a Word catheter repeatedly falls out, marsupialization may be recommended. This surgical procedure creates a permanent opening in the cyst wall, allowing ongoing drainage. It's typically performed under local or general anesthesia.

During marsupialization, the surgeon makes an elliptical incision in the cyst wall and sutures the edges of the cyst lining to the surrounding skin. This creates a pouch (marsupium) that remains permanently open, preventing fluid from accumulating. The recurrence rate after marsupialization is approximately 5-10%, lower than simple incision and drainage alone.

Antibiotics

Antibiotics are not routinely necessary for all Bartholin abscesses. When the abscess is adequately drained, the infection typically resolves without antibiotic treatment. However, antibiotics may be prescribed in certain situations:

• Surrounding cellulitis (spreading skin infection)
• Systemic symptoms like fever or chills
• Immunocompromised patients
• MRSA or other resistant bacterial infections
• Sexually transmitted infections identified on testing

Can You Prevent Bartholin Cysts?

There is no proven way to prevent Bartholin cysts since the exact cause of duct blockage is usually unknown. However, maintaining good vulvar hygiene with gentle cleansing, practicing safe sex to reduce STI risk, and seeking prompt treatment if you develop symptoms may help reduce complications.

Because the underlying cause of Bartholin cyst formation is not fully understood, there are no guaranteed prevention strategies. The duct obstruction that leads to cyst development can occur without any identifiable cause or precipitating factor. However, certain general health practices may help reduce risk or minimize complications.

Maintaining good vulvar hygiene is sensible, though over-washing should be avoided. The vulvar area contains delicate mucous membranes that can be irritated by harsh soaps, scented products, or excessive cleansing. Gentle washing with mild, unscented soap and water during regular bathing is sufficient. Avoid douching, which can disrupt the normal bacterial balance of the vagina and potentially increase infection risk.

Practicing safer sex by using condoms can reduce the risk of sexually transmitted infections, some of which have been associated with Bartholin abscesses. While STIs cause only a minority of Bartholin abscesses, preventing these infections is beneficial for overall reproductive health.

Reducing Recurrence Risk

For women who have had one Bartholin cyst, preventing recurrence is a reasonable concern. Unfortunately, recurrence is common regardless of initial treatment method. Studies suggest that 5-15% of women treated with Word catheter placement and 5-10% treated with marsupialization will experience recurrence. Some strategies that may help include:

• Complete the recommended catheter time: If treated with a Word catheter, keeping it in place for the full 3-4 weeks gives the best chance of forming a permanent drainage pathway
• Avoid premature catheter removal: If the catheter falls out before the recommended time, contact your healthcare provider
• Consider marsupialization for recurrent cysts: This procedure has slightly lower recurrence rates than simple drainage

What Are the Possible Complications?

Most Bartholin cysts resolve without complications, especially with appropriate treatment. Potential complications include recurrence (the cyst returning after treatment), persistent discomfort, scarring from repeated procedures, and rarely, spread of infection to surrounding tissues. Bartholin gland cancer is extremely rare but should be considered in women over 40 with unusual masses.

While Bartholin cysts and abscesses are generally treatable conditions with excellent outcomes, understanding potential complications helps patients make informed decisions and recognize when to seek additional care.

Recurrence is the most common complication, occurring in approximately 5-30% of treated patients depending on the treatment method used. Simple incision and drainage without catheter placement has the highest recurrence rate, while marsupialization and gland excision have the lowest. Recurrent cysts can be frustrating, but each episode can be treated, and most women eventually become free of the problem.

Infection spread can occur if a Bartholin abscess is left untreated. The infection may spread to surrounding soft tissues (cellulitis) or, rarely, enter the bloodstream (sepsis). These complications are uncommon when abscesses are drained promptly and appropriately.