Bartholin gland cyst and abscess !
A Bartholin cyst is a swelling at the back of the vaginal opening from a blocked Bartholin gland duct; if it becomes infected it forms a painful abscess.
Updated 2026-10-29
Structures involved
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Why it happens
- Outcomes of acute inflammation: resolution, abscess, scar or chronic inflammation
- Glands: exocrine vs endocrine, secretion types
What it is
A fluid-filled swelling of a Bartholin gland, at the back of the vulvar vestibule, caused by blockage of its duct. When the fluid becomes infected it forms a painful abscess.
Who gets it
Most often seen in women of reproductive age; uncommon before puberty and after menopause. Abscesses are seen more often than simple cysts in emergency and gynaecology services.
Causes
- Blockage of the Bartholin duct by mucus, scarring, trauma or swelling
- Infection of the retained fluid, usually polymicrobial (skin, vaginal and bowel organisms such as Escherichia coli and anaerobes)
- Less often sexually transmitted organisms such as Neisseria gonorrhoeae or Chlamydia trachomatis
Risk factors
- Reproductive age
- Previous Bartholin cyst or abscess
- Local trauma or vulvar surgery
- Sexually transmitted infection
- Diabetes or immunosuppression (abscess)
Pathophysiology
The paired Bartholin glands lie at about the 4 and 8 o'clock positions of the vestibule and secrete mucus through short ducts that open just outside the hymen. When a duct is obstructed, secretions build up and dilate it into a cyst. Bacteria entering the cyst or the gland produce an abscess with surrounding cellulitis.
Classification
- Bartholin duct cyst: usually painless, may be found by chance
- Bartholin gland abscess: acute, painful and inflamed
- Recurrent cyst or abscess
Symptoms and signs
- Soft, round swelling on one side of the lower vulva, at the entrance of the vagina
- Small cysts often cause no symptoms
- Discomfort when walking, sitting or during intercourse with larger cysts
- Abscess: rapidly growing, very painful, red, hot and tender lump
- Fever is uncommon; the abscess may drain on its own
Diagnosis
- Clinical
- Usually a clinical diagnosis on pelvic examination: a unilateral swelling in the lower lateral vestibule, fluctuant and tender if abscessed.
- Tests
- Culture of pus when there is an abscess; tests for gonorrhoea and chlamydia when there is risk. Biopsy of the gland in older or postmenopausal women or when the mass is solid (age thresholds vary between texts).
- Imaging
- Rarely needed; ultrasound or MRI if the diagnosis is unclear or a deeper mass is suspected.
Differential diagnosis
- Skene duct cyst
- Epidermal inclusion cyst or sebaceous cyst
- Gartner duct cyst
- Hidradenitis suppurativa or folliculitis
- Lipoma or fibroma
- Vulvar or Bartholin gland carcinoma
Goal of treatment
Relieve pain, drain infection and create lasting drainage of the gland to prevent recurrence, while excluding cancer in women at risk.
Treatment
- Conservative
- Small, painless cysts can be observed; warm sitz baths and simple analgesia can help a cyst or early abscess drain on its own.
- Procedure
- Incision and drainage of an abscess with placement of a small balloon catheter (Word catheter) for several weeks so a new duct opening forms; simple incision alone tends to recur.
- Surgical
- Marsupialization (suturing the cyst wall open to the skin) for recurrent cysts or abscesses; excision of the gland is kept for repeated recurrence or suspicion of cancer.
- Medical
- Antibiotics are added when there is surrounding cellulitis, systemic signs, immunosuppression or a confirmed sexually transmitted infection.
Complications
- Recurrence
- Spreading cellulitis
- Bleeding or haematoma after surgery
- Scarring and dyspareunia
- Rarely necrotizing fasciitis
- Missed Bartholin gland carcinoma (rare)
Prognosis
Excellent. Most cysts and abscesses resolve with drainage; recurrence is reduced by catheter drainage or marsupialization compared with simple incision.
Prevention
- Condom use and treatment of sexually transmitted infections
- Early care of small cysts before they become infected
Test yourself
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Where are the Bartholin glands located?
In the posterolateral vulvar vestibule, at about the 4 and 8 o'clock positions, with ducts opening just outside the hymen.
Why is a Word catheter placed after draining a Bartholin abscess?
To keep the incision open for several weeks so a new duct opening epithelializes, lowering the recurrence seen with simple incision.
Which organisms usually cause a Bartholin abscess?
A polymicrobial mix of skin, vaginal and bowel flora such as Escherichia coli and anaerobes; sexually transmitted organisms are less common.
When should a Bartholin gland mass be biopsied?
When it is solid, fixed or irregular, or in older and postmenopausal women, to exclude carcinoma (age cut-offs vary).
Related conditions
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Bartholin Gland Cyst (StatPearls (NCBI Bookshelf), 2025).
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