💧 Bartholin's Cyst

🔑 Key Learning

• Caused by obstruction of the Bartholin's gland duct → mucus accumulation
• Typically presents as a unilateral, medially protruding swelling at 4 or 8 o’clock position
• May be asymptomatic, painful, or form an abscess
• Management depends on symptoms: conservative, antibiotics, drainage, or marsupialisation

🧬 Pathophysiology

• Bartholin's glands are located at the 4 and 8 o'clock positions of the vaginal introitus
• They secrete mucus to lubricate the vulva and vaginal opening
• Duct obstruction causes mucus buildup → cyst formation
• If the cyst becomes infected → abscess develops, often painful and inflamed

👀 Clinical Features

• Asymptomatic swelling: often incidental finding
• Typical location: unilateral swelling at 4 or 8 o’clock on the inferior labia majora
• Pain or tenderness: worsens with walking, sitting, or intercourse
• Dyspareunia due to cyst proximity to vaginal opening
• Bartholin's abscess: erythema, marked tenderness, possible fever

   

💊 Management

Conservative

• Observation if small and asymptomatic

Medical

• Oral antibiotics: if evidence of infection or abscess formation

Surgical

• Incision and drainage: for painful or infected cysts
• Word catheter: placed after drainage to allow continuous drainage and reduce recurrence risk
• Marsupialisation: surgical creation of a new ductal opening, typically for recurrent cysts

📝 Exam Clues & Clinchers

• Unilateral labial swelling at 4 or 8 o'clock position
• Painful lump + fever = likely abscess → incision and drainage + Word catheter
• Recurrent cysts → marsupialisation is definitive