What causes a Bartholin gland cyst?

Causes of Bartholin Gland Cysts

Bartholin gland cysts are primarily caused by obstruction of the Bartholin gland duct, leading to retention of secretions and subsequent cyst formation. 1

Primary Causes

Duct Obstruction

• Mechanical blockage of the Bartholin gland duct, which normally drains into the vestibule at approximately the 4 and 8 o'clock positions of the vulvar vestibule 1, 2
• The blockage prevents normal secretions from exiting the duct, causing fluid accumulation and cyst formation 2

Contributing Factors

1. Infection

   • Bacterial infection can cause inflammation and subsequent blockage of the duct
   • When infected, the cyst becomes an abscess with symptoms of swelling, erythema, and tenderness 1
   • May extend to involve the entire labia minora

2. Inflammation

   • Non-infectious inflammatory processes can lead to narrowing of the duct
   • Chronic inflammation may cause scarring and permanent obstruction 2

3. Trauma

   • Physical trauma to the vulvar area can damage the duct
   • Childbirth-related trauma may contribute to duct obstruction

4. Congenital abnormalities

   • Anatomical variations in the duct structure may predispose to blockage

Clinical Presentation

• Asymptomatic cysts: Many Bartholin duct cysts remain asymptomatic and resolve spontaneously 3
• Symptomatic cysts: Present with vulvar swelling, discomfort during walking or sitting, and dyspareunia
• Infected cysts/abscesses: Present with pain, swelling, erythema, and sometimes purulent discharge 1
• Size variation: Can range from small (pea-sized) to large (several centimeters) 4

Pathophysiology

The Bartholin glands are normally pea-sized and not palpable. They become noticeable only when:

• The duct becomes cystic due to obstruction
• A gland abscess develops from secondary infection 2

When the duct is obstructed:

1. Secretions accumulate within the duct
2. The duct dilates to form a cyst
3. If bacteria invade, an abscess forms

Differential Diagnosis

Bartholin gland cysts must be distinguished from other vulvar lesions:

• Epidermal inclusion cysts
• Skene's duct cysts
• Hidradenoma papilliferum
• Lipomas 2
• In women over 40, malignancy should be considered (including Bartholin gland adenocarcinoma) 5, 1

Management Considerations

• Many asymptomatic Bartholin cysts resolve without intervention 3
• Infected cysts or abscesses larger than 2 cm typically require drainage as they rarely resolve spontaneously 3
• Treatment options include:
  • Word catheter placement (creates a fistulous tract)
  • Marsupialization (creates a permanent opening)
  • Surgical excision (particularly for recurrent cases or when malignancy is suspected) 1

Special Considerations

• Bartholin gland cysts in women over 40 years warrant closer evaluation to rule out malignancy 1
• Recurrent cysts may indicate the need for more definitive treatment like marsupialization or excision 1
• Ultrasound can help differentiate between simple, complicated, and complex cysts 1

Understanding the cause of Bartholin gland cysts is essential for appropriate management and to prevent recurrence, which is a common issue with these lesions.