Bartholin’s gland cyst

Definition

A Bartholin’s gland cyst is a swollen fluid-filled lump that develops from a blockage of one of the Bartholin’s glands, which are small glands located on each side of the opening to the vagina. Bartholin’s gland cysts and abscesses are commonly found in women of reproductive age, developing in approximately 2% of all women.

Description

The Bartholin’s glands are located in the lips of the labia that cover the vaginal opening. The glands (normally the size of a pea) provide moisture for the vulva area. A Bartholin’s gland cyst may form in the gland itself or in the duct draining the gland. A cyst normally does not cause pain, grows slowly, and may go away without treatment. It usually ranges in size from 0.4-1.2 in. (1-3 cm), although some may grow much larger.

If infected, a Bartholin’s gland cyst can form an abscess that will increase in size over several days and is very painful. In order to heal, a Bartholin’s gland cyst usually must be drained.

Causes and symptoms

A Bartholin’s gland cyst occurs if the duct becomes blocked for any reason, such as infection, injury, or chronic inflammation. Very rarely a cyst is caused by cancer, which usually occurs only in women over the age of 40. In many cases, the cause of a Bartholin’s gland cyst is unknown.

Symptoms of an uninfected Bartholin’s gland cyst include a painless jump on one side of the vulva area (most common symptom) and redness or swelling in the vulva area.

Symptoms of an abscessed Bartholin’s gland include:

• pain that occurs with walking, sitting, physical activity, or sexual intercourse
• fever and chills
• increased swelling in the vulva area over a two- to four-day period
• drainage from the cyst, normally occurring four to five days after the swelling starts

Abscesses may be caused by sexually transmitted bacteria, such as those causing chlamydial or gonococcal infections, while others are caused by bacteria normally occurring in the vagina. Over 60 types of bacteria have been found in Bartholin’s gland abscesses.

Diagnosis

A Bartholin’s gland cyst or abscess is diagnosed by a gynecological pelvic exam. If the cyst appears to be infected, a culture is often performed to identify the type of bacteria causing the abscess.

Treatment

Treatment for this condition depends on the size of the cyst, whether it is painful, and whether the cyst is infected.

If the cyst is not infected, treatment options include:

• watchful waiting by the woman and her health care professional
• soaking of the genital area with warm towel compresses
• soaking of the genital area in a sitz bath
• use of non-prescription pain medication to relieve mild discomfort

If the Bartholin’s gland is infected, there are several treatments available to treat the abscess, including:

• soaking of the genital area in a sitz bath
• treatment with antibiotics
• use of prescription or non-prescription pain medication
• incision and drainage, i.e., cutting into the cyst and draining the fluid (not usually successful, as the cyst often reoccurs)
• placement of a drain (Word catheter) in the cyst for two to four weeks so fluid can drain and prevent reoccurrence of the cyst
• marsupialization
• window operation
• use of a carbon dioxide laser to open the cyst and heat the cyst wall tissue so that the cyst cannot form a sac and reoccur
• incision and drainage, followed by treatment with silver nitrate to burn the cyst wall so the cyst cannot form a sac and reoccur
• removal of the entire Bartholin’s gland cyst, if the cyst has reoccurred several times after use of other treatment methods

During surgical treatment, the area will be numbed with a local anesthetic to reduce pain. General anesthesia may be used for treatment of an abscess, as the procedure can be painful.

In a pregnant woman, surgical treatment of cysts that are asymptomatic should be delayed until after delivery to avoid the possibility of excessive bleeding. However, if the Bartholin’s gland is infected and must be drained, antibiotics and local anesthesia are generally considered safe.

If the cyst is caused by cancer, the gland must be excised, and the woman should be under the care of a gynecologist familiar with the treatment of this type of cancer.

Alternative treatment

If a Bartholin’s gland cyst has no or mild symptoms, or has opened on its own to drain, a woman may decide to use watchful waiting, warm sitz baths, and non-prescription pain medication. If symptoms become worse or do not improve, a health care professional should then be consulted.

Infected Bartholin’s glands should be evaluated and treated by a health care professional.

Prognosis

A Bartholin’s gland cyst should respond to treatment in a few days. If an abscess requires surgery, healing may take days to weeks, depending on the size of the abscess and the type of surgical procedure used. Most of the surgical procedures, except for incision and drainage, should be effective in preventing recurring infections.

Prevention

There are few ways to prevent the formation of Bartholin’s gland cysts or abscesses. However, as a Bartholin’s gland abscess may be caused by a sexually transmitted disease, the practice of safe sex is recommended. Using good hygiene, i.e., wiping front to back after a bowel movement, is also recommended to prevent bacteria from the bowels from contaminating the vaginal area.

Key Terms

Marsupialization

Cutting out a wedge of the cyst wall and putting in stitches so the cyst cannot reoccur.

Sitz bath

A warm bath in which just the buttocks and genital area soak in water; used to reduce pain and aid healing in the genital area.

Window operation

Cutting out a large oval-shaped piece of the cyst wall and putting in stitches to create a window so the cyst cannot reoccur.

Word catheter

A small rubber catheter with an inflatable balloon tip that is inserted into a stab incision in the cyst, after the contents of the cyst have been drained.

Genital Herpes

What Is It?

Genital herpes is caused by a virus called herpes simplex (HSV). There are two different types of herpes virus that cause genital herpes — HSV-1 and HSV-2. Most forms of genital herpes are HSV-2. But a person with HSV-1 (the type of virus that causes cold sores or fever blisters around the mouth) can transmit the virus through oral sex to another person’s genitals.

HSV-2 is a sexually transmitted disease (STD). It causes herpes sores in the genital area and is transmitted through vaginal, oral, or anal sex, especially from unprotected sex. Because the virus does not live outside the body for long, you cannot catch genital herpes from an object, such as a toilet seat.

Symptoms of a Genital Herpes Outbreak

Someone who has been exposed to the genital herpes virus may not be aware of the infection and may never have an outbreak of sores. However, if a person does have an outbreak, the symptoms can cause significant discomfort.

Someone with genital herpes may first notice itching or pain, followed by sores that appear a few hours to a few days later. The sores, which may appear on the vagina, penis, scrotum, buttocks, or anus, start out as red bumps that soon turn into red, watery blisters. The sores may make it very painful to urinate. The sores may open up, ooze fluid or bleed, and then heal within the next 2 to 4 weeks.

The entire genital area may feel very tender or painful, and the person may have flu-like symptoms including fever, headache, and swollen lymph nodes. If someone has an outbreak in the future, it will tend to be less severe and shorter in duration, with the sores healing in about 10 days.

How Long Until Symptoms Appear?

Someone who has been exposed to genital herpes will notice genital itching and/or pain about 2 to 20 days after being infected with the virus. The sores usually appear within days afterward.

What Can Happen?

After the herpes blisters disappear, a person may think the virus has gone away — but it’s actually hiding in the body. Both HSV-1 and HSV-2 can stay hidden away in the body until the next herpes outbreak, when the virus reactivates itself and the painful sores return.

Over time, the herpes virus can reactivate itself again and again, causing discomfort and episodes of sores each time. Usually a person has about four to five herpes outbreaks each year — but in some people, the number of outbreaks will lessen over time.

There is no cure for herpes; it will always remain in the body and can always be passed to another person with any form of unprotected sex. This is the case even if blisters aren’t present on the genitals. Many cases of genital herpes are transmitted when symptoms are not present.

Genital herpes also increases the risk of HIV infection. This is because HIV can enter the body more easily whenever there’s a break in the skin (such as a sore) during unprotected sexual contact. In addition, if a pregnant woman with genital herpes has an active infection during childbirth, the newborn baby is at risk for getting herpes infection. Herpes infection in a newborn can cause meningitis (an inflammation of the membranes that surround the brain and spinal cord), seizures, and brain damage.

How Is It Prevented?

The only surefire way to prevent genital herpes is document.write(defabstinence120) abstinenceabstinence. Teens who do have sex must properly use a latex condom every time they have any form of sexual intercourse (vaginal, oral, or anal sex). Girls receiving oral sex should have their partners use dental dams as protection. These sheets of thin latex can be purchased online or from many pharmacies.

If one partner has a herpes outbreak, avoid sex — even with a condom or dental dam — until all sores have healed. Herpes can be passed sexually even if a partner has no sores or other signs and symptoms of an outbreak.

How Is It Treated?

If you think you may have genital herpes or if you have had a partner who may have genital herpes, see your family doctor, adolescent doctor, gynecologist, or health clinic for a diagnosis. Right now, there is no cure for genital herpes, but a doctor can prescribe antiviral medication to help control recurring HSV-2 and clear up the painful sores. The doctor can also tell you how to keep the sores clean and dry and suggest other methods to ease the discomfort when the virus reappears.

Woman Genital Helath (2)

Common genital problems

Vaginal problems

A variety of bacteria, yeasts and other micro-organisms occur naturally in the vagina. Specific bacteria (lactobacilli) normally keep the vagina slightly acidic, keeping the growth

of other bacteria under control.

The vaginal balance can be upset by external factors. This can lead to a change in the balance of the natural bacteria in the vagina, causing problems. Some women are more prone than others to disturbance of the vaginal environment.

A course of antibiotics may reduce the numbers of bacteria that the vagina needs to keep

its normal acidic balance. Stress, illness and hormone changes can also alter the vaginal environment.

Signs of a vaginal problem may be:

• itching, irritation or soreness around the vaginal opening

• a burning sensation when urinating

• increased or unusual discharge

• swelling of the labia

• abnormal bleeding

• uncomfortable or painful sex

• an unpleasant odour

If you are experiencing any of the above problems, see a doctor or FPWA clinician.

Genital itch

Genital itch is a common problem among women. Many assume that any genital itch is due to thrush (see below for more information), but there are other conditions that can cause itching and soreness, such as eczema (dermatitis).

If you are experiencing persistent genital itch, it is important to see a doctor or FPWA clinician to get an accurate diagnosis, so that you can be given the right treatment.

Vulval pain

Vulval pain is a problem for many women, and can be caused by both physical and psychological factors. It can make inserting tampons or having sex difficult or impossible. Some women find the area too painful to even touch.

Some vulval problems have noticeable signs, such as a growth, sore or rash on the vulva. These can often indicate an infection or skin condition such as eczema or dermatitis, and need to be checked by a doctor.

Some women experiencing vulval pain have no other physical symptoms but experience pain some or all of the time, in particular when urinating or sitting for long periods.Because of the lack of other symptoms, these problems can be difficult to diagnose. Physical therapy is often used to treat vulval pain, but avoiding intercourse, wearing loose clothing and using cold packs can help. Your doctor may prescribe antidepressants or anti-epileptic medication to reduce the pain, or a special cream to apply to the area. Counselling or therapy may be beneficial if the pain is due to psychological causes.

Although not usually an indication of a serious condition, if you are experiencing recurring vulval pain it is important to see a doctor - don’t try and treat the problem yourself. Occasionally however, pain can be related to conditions such as cancer.

Vaginal infections

Infection can be avoided by:

• wiping from front to back when using toilet paper

• being particularly careful with hygiene if you have a bowel upset e.g. washing rather than wiping

• eating a healthy, well balanced diet

• not douching (flushing liquids into the vagina)

Common vaginal infections

Thrush

This infection is also called monilia or candida. The organism is a yeast which is commonly found in the body without causing any problems. At times a woman may notice symptoms, particularly during pregnancy, or when she is on antibiotics or some other medication. Women who are diabetic or who have other illnesses may have recurring problems with thrush.

Common symptoms of thrush can include itchiness, burning, soreness, a thick white or yellow discharge, discomfort during intercourse and pain when urinating. Sometimes men may also notice irritation and redness of the penis after sex if their partner has thrush, but it is not considered to be a sexually transmissible infection (STI).

Thrush is diagnosed by examination and confirmed by taking swabs.

It may also be detected on a routine Pap smear.

Thrush does not have to be treated if it is not bothering you. Some women find their symptoms can be relieved by sitting in a warm salty bath or by using cold compresses.

If you are certain that thrush is the cause of your symptoms, antifungal vaginal creams and pessaries are available over the counter at pharmacies. If you are finding that thrush is a frequent problem it is advisable to visit your doctor or the FPWA clinic. Your doctor will examine you to confirm that thrush is the cause of your symptoms and may prescribe other treatments such as oral antifungal tablets. The doctor may take this opportunity to rule out the possibility of STIs, which can also cause irritation.

Putting yogurt on an irritated vulva will not get rid of the infection.

Bacterial vaginosis

This is a common condition in women and is caused by an overgrowth

of bacteria that normally live in the bowel but may be found in the vagina. The organisms often multiply in the vagina when the acid level falls.

Bacterial vaginosis may cause a white to grey discharge with an unpleasant ‘fish‘ or stale odour. Vulval irritation can occur and sex may be uncomfortable. Bacterial vaginosis is diagnosed by an examination testing the acidity of the vaginal fluid, and confirmed by swabs.

Bacterial vaginosis does not have to be treated if it is not bothering you.

If it is a problem your doctor may prescribe antibiotics in the form of tablets or vaginal cream. The FPWA clinic or your doctor may also recommend treatment if you are planning to have an intrauterine contraceptive device fitted or any gynaecological operation.

Telling partners

It is a good idea to talk to your partner if