Causes of Bartholin Cysts in Women of Reproductive Age
Bartholin cysts develop primarily from obstruction of the Bartholin gland duct opening into the vestibule, leading to mucus accumulation and cyst formation. 1, 2
Primary Mechanism
- Duct obstruction is the fundamental cause, resulting in mucus build-up within the gland ducts that normally drain at the 4 and 8 o'clock positions of the posterior vestibule 1, 2
- The obstruction prevents normal mucus secretion and vaginal lubrication function, causing progressive cystic enlargement 2
Infectious Causes (When Cysts Become Abscesses)
When Bartholin cysts become infected and progress to abscesses, the microbiology reveals important patterns:
- Opportunistic organisms are the most common culprits, occurring either as single agents or polymicrobial infections 3
- Aerobic organisms predominate, with coliforms being the most frequently isolated bacteria 3
- Polymicrobial infections are common, involving multiple bacterial species simultaneously 3
Important Clinical Distinction
- Sexually transmitted pathogens (N. gonorrhoeae and C. trachomatis) are NOT the typical cause in contemporary populations, contrary to older teaching 4, 3
- While the American Academy of Pediatrics notes that Bartholin glands can be infected by STI pathogens including gonorrhea and chlamydia, actual culture data shows these are rarely encountered in practice 4, 3
Gland Hyperplasia (Less Common Presentation)
- Nodular hyperplasia of the Bartholin gland itself can occur, presenting with nodular enlargement deep in the labium majus, sometimes with duct rupture into subcutaneous tissue 5
- This presents with subcutaneous free-floating mucus and nodular swelling, especially during sexual arousal 5
- This variant is easily misdiagnosed due to its rarity and diverse clinical presentations 5
Key Clinical Pitfalls to Avoid
- Do not assume all Bartholin masses are simple cysts—the differential includes epidermal inclusion cysts, Skene's duct cysts, hidradenoma papilliferum, and lipomas 1
- In menopausal or perimenopausal women with irregular, nodular Bartholin masses, consider adenocarcinoma and perform excisional biopsy 1
- Do not routinely prescribe antibiotics for uncomplicated cysts—broad-spectrum antibiotic therapy is warranted only when cellulitis is present 1