Managing Recurrent Bartholin Gland Cysts: To Remove or Not?

Regarding the issue of recurrent Bartholin's gland cysts?

I had a Bartholin's gland cyst when I was younger, which required a marsupialization procedure.
It started recurring in April of last year, with 6 to 7 recurrences within a year.
I also underwent two drainage marsupialization procedures in between, but the cysts keep coming back.
Therefore, I am considering a complete excision of the Bartholin's gland; however, the doctors I have consulted have advised against this procedure.
I would like to know if excision would have any implications for other health issues, such as other gynecological conditions.
I want to evaluate the potential impacts of excision before making a decision.
If I choose not to have the excision, what recommendations do you have for routine care to reduce the frequency of recurrences? Thank you.

YING, 20~29 year old female. Ask Date: 2015/08/07

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
The function of the Bartholin's glands is solely to increase vaginal lubrication; their removal will not affect menstruation or pregnancy.
2.
The surgical procedure for removing the Bartholin's glands can be painful, so general anesthesia is recommended.
It is not suitable to be performed in a clinic, so please register at a large hospital and consult an obstetrician-gynecologist for arrangements.
3.
Please try to wear breathable clothing and keep the vulva dry to reduce the risk of recurrence.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/08/07

More Info

Managing recurrent Bartholin gland cysts can be quite challenging, especially when they lead to frequent discomfort and require multiple drainage procedures. The decision to remove the Bartholin gland entirely is a significant one and should be made after careful consideration of the potential benefits and risks involved.

Understanding Bartholin Gland Cysts
Bartholin glands are located on either side of the vaginal opening and are responsible for secreting fluid that helps lubricate the vagina. When these glands become blocked, fluid can accumulate, leading to the formation of cysts. If the cyst becomes infected, it can develop into an abscess, which is often painful and may require drainage.

Surgical Options
1. Drainage Procedures: As you've experienced, repeated drainage can provide temporary relief but may not prevent recurrence. This is often the first line of treatment for symptomatic cysts or abscesses.

2. Marsupialization: This procedure involves creating a small opening in the cyst and stitching the edges to the vaginal wall, allowing continuous drainage. This can be effective in reducing recurrence rates compared to simple drainage.

3. Complete Gland Excision: This is the surgical removal of the entire Bartholin gland. While it can effectively eliminate the source of the cysts, it is generally reserved for cases where other treatments have failed or when the cysts are causing significant issues.

Risks of Excision
While complete excision can be effective, it is essential to consider the potential risks and complications:
- Infection: Any surgical procedure carries a risk of infection.

- Scarring: Surgical removal may lead to scarring, which could potentially affect vaginal function.

- Impact on Sexual Function: Although many women report no change in sexual function post-surgery, some may experience changes in lubrication or sensation.

- Other Gynecological Issues: There is limited evidence suggesting that complete removal of the Bartholin gland may lead to other gynecological issues, but this is not well-documented. The gland's role in lubrication is significant, and its removal could theoretically impact vaginal health.

Non-Surgical Management and Prevention
If you decide against surgical intervention, there are several strategies you can adopt to help manage and potentially reduce the recurrence of Bartholin gland cysts:
1. Hygiene: Maintain good genital hygiene to reduce the risk of infections that can lead to cyst formation.

2. Warm Compresses: Applying warm compresses to the area can help relieve discomfort and promote drainage if a cyst begins to form.

3. Avoid Irritants: Be mindful of products that may irritate the vaginal area, such as scented soaps or douches.

4. Regular Check-ups: Regular visits to your gynecologist can help monitor the situation and catch any changes early.

5. Diet and Hydration: Staying hydrated and maintaining a balanced diet can support overall health and potentially reduce the likelihood of cyst formation.

Conclusion
The decision to remove the Bartholin gland should be made in consultation with a healthcare provider who understands your specific medical history and the severity of your condition. If multiple drainage procedures have not provided lasting relief, discussing the potential benefits and risks of gland excision with a gynecologist is advisable. They can help you weigh the pros and cons based on your individual circumstances and provide guidance on the best course of action moving forward. If you choose to manage the cysts non-surgically, implementing preventive measures can help reduce recurrence and improve your quality of life.

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