Vulvar Cysts

VULVAR CYSTS

Bartholin’s cyst results from the obstruction of a duct in one ofthe paired vestibular glands located in the posterior third of the vulva, near the vestibule. This cyst is the most common of vulvar tumors. A simple cyst may be asymptomatic, but an infected cyst or abscess may cause discomfort. Infection may be due to a gono-coccal organism, Escherichia coli, or S. aureus and can cause an ab-scess with or without involving the inguinal lymph nodes. Skene’s duct cysts may result in pressure, dyspareunia, altered urinary stream, and pain, especially if infection is present. Vestibular cysts, located inferior to the hymen, may also occur.

Medical Management

The usual treatment for a Bartholin’s cyst is incision and drainage followed by antibiotic therapy. If a cyst is asymptomatic, treatment is unnecessary. Moist heat or sitz baths may promote drainage and resolution. If surgery is necessary, a Word Bartholin gland catheter is usually used. This catheter, a short latex stem with an inflatable bulb at the distal end, creates a tract that preserves the gland and allows for drainage. A nonopioid analgesic agent may be adminis-tered before this outpatient procedure. A local anesthetic agent is injected, and the cyst is incised or lanced and irrigated with nor-mal saline; the catheter is inserted and inflated with 2 to 3 mL of water. The catheter stem is then tucked into the vagina to allow freedom of movement. The catheter is left in place for 4 to 6 weeks until the tract re-epithelializes. The patient is informed that dis-charge should be expected, as the catheter allows drainage of the cyst. She is instructed to contact her primary health care provider if pain occurs because the bulb may be too large for the cavity and fluid may need to be removed. Routine hygiene is encouraged.

Skene’s duct cysts can be excised or drained with a Word catheter. Vestibular cysts are excised if symptomatic.