Bartholin’s cyst treatment in Hyderabad, India

Diagnosis of Bartholin’s cyst may depend on factors such as history and physical examination, which help the gynaecologist to conclude the diagnosis. The Bartholin cyst is subject to the treatment of the painful symptoms. The gynaecologist considers the following before selecting the appropriate tests to diagnose Bartholin's cyst: 

• The presented signs and symptoms
• Presence of pain
• Fever
• Drainage of fluid from the mass and whether the drainage was purulent
• Previous history of vulvar mass, other vulvar conditions, or surgery
• Comorbidities, including diabetes or immunosuppression
• The results of previous medical tests
• Physical examination
• Visual inspection of the vulva
• Palpation of the Bartholin’s gland
  

🔷The presented signs and symptoms of Bartholin’s cyst

• Presence of pain: A gynaecologist asks the patient if the mass is painful, whether the pain is constant or intermittent, whether it is worsening, and if there is pain with activity, including sitting, walking, or during sexual intercourse. Cysts may be nonpainful or associated with mild pain, but a gynaecologist asks about pain to determine whether the Bartholin abscess is present because Bartholin abscesses are typically very painful.
• Fever: A patient should be asked about fever because one-fifth of patients with abscesses present with fever (febrile).
• Drainage of fluid from the mass and whether the drainage was purulent: If drainage was present, the patient should be asked about the colour of the drainage. Typically, cysts are present with clear or white fluid. Abscesses usually have pus (purulent discharge) that is generally yellow or green. 

🔷Previous history of vulvar mass, other vulvar conditions, or surgery

Patients can be asked about their previous history of vulvar mass (especially Bartholin’s mass), other vulvar conditions, or surgery. A prior history of Bartholin cyst or abscess or previous surgeries may increase the risk of Bartholin’s cyst and also impact the vulvar examination or surgical planning.

🔷The results of previous medical tests

A gynaecologist may ask about the reports of earlier medical tests to get valuable information to confirm the presence of Bartholin’s cyst or abscess in a patient and to choose the proper diagnosis and treatment.

🔷Comorbidities, including diabetes or immunosuppression

Knowing the comorbidities will help the gynaecologist select the appropriate treatment because they may impact the severity of the infection and wound healing.

🔷Physical examination

It is performed in all patients, which includes:

Visual inspection of the vulva: During this exam, a gynaecologist first inspects the vulva (external genitalia), including the lips of the vagina, visually to see if any lumps or swelling are present.

Palpation of the Bartholin’s gland: Palpates (Feels) the Bartholin gland by gently pressing between the inner vaginal lips with a finger inside the vagina and the thumb on the outside to feel any abnormal lumps, because a normal Bartholin gland is not palpable until it has developed any abnormal lumps (cysts or abscesses).

• Usually, a Bartholin cyst is soft and painless, ranges from 1 to 3 cm in size, and is present on one side. However, a Bartholin abscess is typically (3 to 6 cm in size) larger than a Bartholin cyst and is usually unilateral.
• On examination, an abscess is a soft, tender, warm, or fluctuant mass, sometimes surrounded by inflammation and swelling.
• If the abscess is very close to the surface area, pus may break through the thin layer of skin at a point and may drain spontaneously.
• Rarely, a complete physical examination will be performed in patients suspected of having a systemic infection (An infection that presents in the bloodstream). 
  

Based on the above information, a gynaecologist advises the diagnostic tests to detect infections or cancers. The following are the tests that might be recommended to diagnose Bartholin cysts or abscesses:

• Abscess cultures
• Biopsy
  

Abscess cultures

• Gynaecologists send samples of vaginal discharge to look for any infection . If pus (purulent) material is present during incision and drainage (I&D) or in a draining abscess. A gynaecologist obtains cultures of abscesses for aerobic bacteria and performs nucleic acid amplification testing for gonorrhoea and chlamydia in patients at risk of sexually transmitted infections (STIs).
• In case of suspicion of sexually transmitted infections, then a sexually transmitted infection panel (including gonorrhoea and chlamydia) should be considered to initiate the appropriate treatment. 

Biopsy

• Although cysts in the Bartholin glands are common, it's crucial to monitor them because they could develop into carcinomas. Hence, sometimes, a gynaecologist may recommend a biopsy to check for signs of carcinomas, including a rare type of vulvar cancer called Bartholin's gland cancer. This is also considered an effective tool for differentiating between differential diagnosis and Bartholin's gland cysts. 
• During the biopsy, a small sample of cyst tissue will be removed from the gland and sent to the laboratory to examine under the microscope and perform at the time of incision and drainage, marsupialization, or gland excision. 
• The biopsy will be recommended for patients over the age of 40 or for patients of any age with suspicion of malignancy of the Bartholin gland or other vulvar site. The following are the conditions under which a gynaecologist recommends a biopsy. If the patient is: 
• Postmenopausal
• Present a mass with a solid component
• Despite treatment, the mass remains persistent (worsening or unresponsive)
• Has a cyst or abscess wall that is fixed to the surrounding tissue
  

A differential diagnosis is a list of possible medical conditions or diseases that can share the same symptoms in a person. Below are some of the conditions that are included in the differential diagnosis of a Bartholin’s cyst:

• Other cysts (inclusion, Gartner, Skene, sebaceous, canal of Nuck) 
• Endometriosis: It is a condition where the tissue similar to the lining of the uterus that grows outside the uterus.
• Myeloid sarcoma: A rare type of cancer that is made up of myeloblasts (a type of immature WBC).
• Fibroma (uterine fibroids): It is a non-cancerous tumour or growth which consists of fibrous, connective tissue. 
• Myoblastoma: It is a non-cancerous growth derived from muscle tissue.
• Vaginal prolapse: It is a condition that is characterized by the dropping of the vaginal wall or cervix into the vaginal canal or outside the vagina due to weakened pelvic floor muscles and tissues. 
• Lipoma: A round or oval-shaped tissue lump that develops beneath the skin.
• Ischiorectal abscess: It is a painful pus collection that forms in the tissues near the anus.
  

A gynaecologist considers the following before planning treatment:

• Patient age 
• Whether the cyst is continuing to enlarge or persists after several days of soaking that area in hot water (sitz bath or in a tub)
• Whether the cyst is having pain or interfering with walking, sitting, and sexual intercourse
• Whether the cyst is infected
• Whether the patient is pregnant
• Whether the patient has tried any of the treatments before
• History of recurrence 

Treatment may not be required if the patient's symptoms are mild and there are no painful symptoms. Clinical judgment and the woman's preferences play a vital role in a gynaecologist’s decision regarding selecting a treatment approach while treating the patient. Various methods are available, and healing can depend on the level of infection, treatment method, and patient's condition.