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What's a Bartholin's gland?

They are two tiny glands, each the size of a peanut buried in the soft tissue of the labia majora - the outer lips of the vulva. Normally you can't see or feel these glands. They secrete small amounts of a thick viscous liquid. Each gland ejects its secretions along a short duct called Bartholin's duct, into the area just outside the vaginal opening.

Bartholin's cysts and abscesses

When something blocks a Bartholin's duct, the secretions have no way out. Thick liquid accumulates and the duct enlarges along with the gland. This is called a Bartholin's cyst. The size varies and these cysts tend to enlarge with time. It is important to note that the actual cause of duct obstruction is unclear.

Infection is the next step. When bacteria enters the fluid-filled cyst, intense inflammation, cellular migration, and pus formation lead to an abscess. A Bartholin's abscess can sometimes be excruciatingly painful. Fever, severe labial pain and redness in the vulva are a few common presentations of a Bartholin's abscess. About three percent of all women get a Bartholin's cyst or abscess sometime during their lives. Younger women in their 20s and 30s are the usual victims, and bacteria like Staphylococcus and Escherichia Coli are the most common culprits.

What are the treatment options?

Not all Bartholin's cysts need treatment. Most do not cause any trouble. Some resolve on their own and other progress very slowly. Getting yourself checked by a gynecologist is essential to exclude other causes of lumps at vulva.

Cystocele, rectocele, urethrocele and utero-vaginal prolapse are other common causes of lumps at vulva.

A Bartholin's abscess needs treatment. Antibiotics and pain killers relieve symptoms in many cases. A small surgery to remove the pus is the next step in stubborn cases. The aim is to prevent recurrence. The doctor may numb the vulval region with a local anesthetic injection or give general anesthesia.

The first step is a small cut close to the vaginal opening to drain out any fluid or pus. After all the pus comes out, the doctor places a few stitches to fix the inner lining of the cyst to the overlying skin, forming a permanent channel for excess Bartholin's gland secretions to come out. This is called marsupialization.

What are the risks of surgery?

As with any surgical procedure, there are some risks associated with marsupialization. Bleeding and infection are the two most common complications.

Bleeding may be immediate or delayed. Belated bleeding from the surrounding granulation tissue presents as bruising, swelling and pain. Symptoms may vary according to the severity of the secondary bleed. An infection worsens the pain.

Bruising after surgery may suggest the presence of bleeding disorders. In patients with hemophilia, blood does not clot quickly. Heavy bleeding under the skin shows up as bruising.

General anesthesia has its own set of risks. The anesthesiologist will explain these before the surgery. In experienced hands complications are rare.

The choice between local anesthesia and general anesthesia should follow an in depth clinical assessment.

A Bartholin's cyst will not usually recur after successful surgical treatment.

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