【Women Without Innocence】

From time to time,Women Without Innocence we all experience lumps and bumps around our genitals. That’s just a given. And because it’s so common, it’s hard to know when it’s time for a trip to the doctors and when everything’s just fine and dandy. 

As a general rule of thumb, we recommend speaking to a medical professional whenever anything pops up and starts bothering us around the genitals to rule out anything serious. And if you have a lump near your vaginal opening, it could be a Bartholin’s cyst — a lesser known type of cyst affecting people with vaginas. 

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It’s an odd name, we know. It’s named after a Danish doctor who identified Bartholin's gland (where the cysts develop) way back in the 17th century. It’s hard to spell, but with the help of gynaecologists and GPs, we’ll go through what a Bartholin’s cyst is, where it's located, how they’re caused, the signs and symptoms, and what to do if you’re experiencing them.

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What is a Bartholin’s cyst?

Put plainly, a Bartholin’s cyst is a fluid-filled swelling on one of the Bartholin’s glands, which are located on each side of the opening of the vagina, on the lips of the labia minora. These glands produce vaginal lubricating fluid which helps protect vaginal tissue during sexual intercourse.

Gynaecologist and founder of condom company HanxSarah Welsh explains to Mashable that a Bartholin's cyst is a "small fluid-filled sac at the Bartholin’s gland, which is just inside the opening of the vagina. The Bartholin’s glands are normally pea-sized (about 1cm) and secrete fluid to lubricate the vagina during sex." If that gland becomes blocked, she explains, they can cause a cyst.

"If this cyst becomes infected (where pus collects inside), this can also develop an abscess, which can cause the area to become red, tender, and swollen," she adds. 

Dr. Deborah Leefrom the Dr Fox Online Pharmacy says: "Bartholin’s glands are found in the genital area. If you are looking directly at the vaginal opening in front of you, they are found at 4 o’clock and 8 o’clock, at either side of the vaginal opening."

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She explains that a Bartholin’s cyst will occur when the duct of Bartholin’s gland becomes blocked, so it is unable to drain naturally, and fluid accumulates inside it. "Normally, the glands are not noticeable and only become evident if they fill up with fluid and form a cyst. Usually, these occur only on one side or the other."

Bartholin’s cysts are not particularly common. They account for 2percent of gynaecology referrals every year. They become more common after puberty and less common after menopause. However, six caseshave been reported in young girls who have not yet started puberty. Basically, it’s always worth looking out for them no matter your age. 

One studyshows that Bartholin's cysts (and abscesses, which can develop from Bartholin’s cysts) were more common in pregnant women, especially if they’d had a  Bartholin’s cyst or abscess in the past. And thankfully, they do not affect fertilityat all.  

Is a Bartholin’s cyst an STI?

A Bartholin’s cyst is not a sexually transmitted infection, it is simply a cyst and could be caused by an array of factors and sometimes they happen randomly. However, if you become infected with an STI as well as having a cyst, then the cyst can become infected and develop into a serious abscess. 

STIs only rarelycause a Bartholin’s abscess, so STI testing is not routine to avoid them specifically. However, you should be regularly tested for STIs (after every new sexual partner is best) so you’re aware of your status and you can make informed choices about your sexual and reproductive health. 

What are the symptoms of a Bartholin’s cyst?

The Bartholin's glands produce a fluid which helps lubricate the vagina during sexual intercourse. Therefore, Lee explains that the cyst may be uncomfortable and press on surrounding structures. This can cause: 

• Painful sex.

• Painful symptoms when passing urine.

• An uncomfortable feeling when sitting, standing or walking.

• Fluid leaking from the glands, which may be blood-stained.

• Discomfort while wiping yourself around your genitals, such as after urination.

Because the glands are part of the genitals, there is a risk they may become secondarily infected by STIs or a transfer of bacteria.  

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Lee says: "This may be with common bacteria found on the skin such as staphylococci or streptococci or could be from bacteria which originate in the bowel such as E.coli." This kind of cross-contamination between the anus region and the vagina, vulva and surrounding areas is relatively common. 

"When infected, they fill with pus to form a Bartholin's abscess. Sometimes, a Bartholin's cyst can be infected with sexually transmitted infections such as gonorrhoea or chlamydia," Lee warns. 

What are the signs of a Bartholin’s cyst to look out for? 

If you have a Bartholin’s cyst, you may be able to feel a lump just inside the vaginal opening. "You may be able to see a swelling or bulge on one side of the vagina which does not look symmetrical," says Lee. "Insert two fingers into the vagina and feel downwards and backwards and off to one side – either left or right as they are usually [exactly side by side]." She adds that it may or may not be tender to touch. If it is infected, it is likely to feel hot, and the skin overlying it at the vaginal opening may look red and angry.  

"If the cyst is small, and not causing any symptoms, it can be left alone. If you have discomfort or pain in this area and find a tender lump as described above, this could be an infected Bartholin's cyst, and you must see your GP," she says. 

"However, if you have any lumps in the genital region, I would strongly advise you to see your GP for a proper check-up." It’s always worth ruling out more serious outcomes by seeing a medical professional and getting a proper diagnosis and treatment. 

"If you have any symptoms such as high temperature, drowsiness, nausea, vomiting, and lethargy – this is an emergency," she stresses. "A Bartholin's cyst could be a cause of sepsis, so you need to get emergency help without delay." 

What to do if you think you have a Bartholin’s cyst 

If you don’t have any symptoms, you should still make an appointment to get everything checked over and ensure that you are healthy and there isn’t another root cause behind your lumps and bumps.

Though, it’s worth noting that an asymptomatic Bartholin’s cyst is usually not a cause for alarm, and you’ll probably be okay to let it go on its own without treatment. 

"If you have localised symptoms such as a painful and tender cyst, see your GP promptly," says Dr Lee. "Soak the cyst in a warm bath and take some painkillers such as paracetamol and/or ibuprofen. Never try to burst the cyst yourself at home." 

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How can you treat a Bartholin’s cyst? 

There are two main ways of treating a Bartholin’s abscess according to research. 

• Incision and drainage

The abscess is incised and drained (cut open), and a flexible tube called a Word catheter is inserted into the abscess cavity, and left to drain for four weeks. This stops the abscess from resealing itself and abscess recurring. 

• Marsupialization

This is a gynaecological procedure in which the abscess is incised, and the flaps at the edge are turned back on themselves and stitched down, again to stop the abscess from resealing itself. 

Lee explains that, In both scenarios, antibiotics are also given – including those which prevent methicillin-resistant staphylococcus aureus (MRSA). Pus from the abscess will be sent for culture and antibiotic sensitivities. 

"Unfortunately, they are sometimes difficult to treat and can recur," she warns. "The last resort is the removal of Bartholin's gland altogether. They may need to be biopsied, to confirm the diagnosis, and exclude other much rarer causes, which can include malignancies."

How to prevent a Bartholin’s cyst 

While the cause of Bartholin’s cysts is sometimes unknown and can happen randomly, there are some things you can do to prevent them from forming. Welsh says the reason the Bartholin ducts become blocked is often unknown, but it can be sometimes linked to infections like STIs and e-coli. The latter is usually spread by transferring bacteria from the bum to the genitals, often by wiping incorrectly or by mixing anal and vaginal sex without proper cleaning. 

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"Therefore, the best way to avoid getting a Bartholin’s cyst or abscess is to protect yourself from infections. This includes wearing condoms for STI protection, peeing after to sex to flush out bacteria in the area, and ensuring good vulval hygiene," Welsh tells Mashable. 

"Remember, good vulval and vaginal hygiene does notmean douching or washing with scented products, as this can have a detrimental effect on your vaginal microbiomeand in turn cause you to be more susceptible to infections. In fact, washing externally with gentle soap and water is all that’s needed."

Bartholin’s cysts and abscesses are very common and it’s often unclear exactly why they develop. So, Welsh says it’s important not to feel embarrassed or upset if you do get one. "Don’t beat yourself up about it — they are not a reflection of poor hygiene or sex practices, and the majority of cases just appear out of the blue without any known reason," she says.

When it comes to sexual health problems, don’t ever let shame or embarrassment stand in the way of seeking medical assistance. Your health is important. If you feel any lumps or bumps down there or experience these symptoms, speak to your GP.