Bartholin's Cyst: Symptoms, Treatments, and Complications

Bartholin's gland cyst

Hello Dr.
Chang,
I had my second child over five years ago, and shortly after, I experienced my first Bartholin's gland cyst, which was accompanied by blood and pus and caused severe pain.
The second occurrence happened a year ago, and since then, I have had approximately 3 to 4 recurrences.
The most recent episode was on August 1, when I suddenly experienced pain in the left Bartholin's gland cyst, followed by a fever of 39 degrees Celsius the next day (both the obstetrics and gynecology and infectious disease specialists said that a Bartholin's gland cyst should not cause a fever).

On that day, I first went to the obstetrics and gynecology clinic, where they aspirated but found no pus or blood, and the cyst was not very enlarged.
However, I experienced significant pain while standing and walking (dull pain? sharp pain?).
Since there were no other symptoms, I was advised to see an infectious disease specialist.
The infectious disease doctor prescribed Augmentin 1# bid for three days, but there was no improvement.

On August 4, I returned to both the obstetrics and gynecology and infectious disease specialists.
The obstetrics and gynecology doctor noted that the cyst was not very enlarged and that upon palpation, there seemed to be inflammation deep within.
They did not perform aspiration and recommended continuing Augmentin for another three days, with a plan for a possible incision and drainage if there was no improvement.
The infectious disease doctor performed blood tests and suggested not to take antibiotics for now, but to take antipyretics regularly, and to return if the fever persists for a week.
As of August 6, the Bartholin's gland cyst has not improved, but it has not worsened either.
I would like to ask the doctor: 1.
If there is no improvement and I choose not to undergo incision and drainage, what would be the implications or differences if I were to directly remove the gland instead? 2.
The doctors I consulted mentioned that a Bartholin's gland cyst should not cause a fever, but I found articles online stating that it is possible for it to cause fever.
This has left me quite confused.
Thank you, Dr.
Chang.

Tina, 40~49 year old female. Ask Date: 2017/08/06

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the lubrication secreted by the Bartholin's glands helps prevent vaginal dryness and facilitates sexual intercourse.
It is recommended to consider a surgical procedure such as a marsupialization if antibiotic treatment has not improved the condition.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/08/06

More Info

Bartholin's cysts are fluid-filled sacs that develop near the vaginal opening, often resulting from blocked Bartholin's glands. These cysts can become painful, especially if they become infected, leading to complications such as abscess formation. Your experience with recurrent Bartholin's cysts and the associated symptoms, including fever and pain, raises important considerations regarding management and treatment options.

1. Understanding Symptoms and Complications: The symptoms of a Bartholin's cyst can vary. While many cysts are asymptomatic, they can cause discomfort, especially if they become inflamed or infected. Pain during walking or standing, as you described, is common when the cyst is inflamed. Fever can occur if there is an infection, even though some healthcare providers may not typically associate fever with Bartholin's cysts. This discrepancy may arise from the fact that not all cysts become infected, and the presence of fever often indicates a more systemic response to infection.

2. Treatment Options: The management of Bartholin's cysts typically involves conservative measures initially. If the cyst is not causing significant discomfort, observation may be recommended. However, in cases where the cyst becomes painful or infected, interventions such as aspiration (draining the fluid) or incision and drainage may be performed. Antibiotics, like Augmentin, may be prescribed if there is a suspicion of infection.

If your symptoms persist despite these treatments, surgical options may be considered. The two primary surgical interventions are marsupialization and gland excision. Marsupialization involves creating a permanent opening in the cyst to allow continuous drainage, which can prevent recurrence. Gland excision, on the other hand, involves removing the entire Bartholin's gland.
3. Risks of Gland Excision: If you opt for gland excision instead of marsupialization, there are several factors to consider. While excision may reduce the likelihood of recurrence, it can also lead to complications such as:
- Increased Risk of Infection: Removing the gland may increase the risk of postoperative infections.

- Changes in Vaginal Secretions: The Bartholin's glands contribute to vaginal lubrication. Their removal may lead to changes in vaginal secretions, potentially causing dryness.

- Surgical Risks: As with any surgical procedure, there are risks associated with anesthesia, bleeding, and scarring.

4. Follow-Up and Monitoring: Given your recurrent symptoms and the recent fever, it is crucial to maintain close follow-up with your healthcare providers. If your symptoms do not improve with conservative management, further evaluation may be warranted. This could include imaging studies to assess the cyst's characteristics or exploring other potential causes of your symptoms.

5. Communication with Healthcare Providers: It is essential to communicate openly with your healthcare providers about your symptoms, concerns, and the impact on your quality of life. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a specialist in gynecology or a pelvic floor specialist may provide additional insights and options.

In summary, Bartholin's cysts can be a source of significant discomfort and complications. While conservative management is often effective, persistent or severe symptoms may warrant surgical intervention. Understanding the risks and benefits of each treatment option, including the potential for fever and infection, is crucial in making an informed decision about your care. Always consult with your healthcare provider to tailor the treatment plan to your specific situation.

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