Dear Alice,

My wife discovered an unnatural lump on the one side of the labia some four years ago. It was small and never bothered her. She is currently 23 years old. After we got married recently, and she became sexually active, the lump has increased in size, and is sometimes painful. I took her to the local ER where the GP on duty examined her and diagnosed it as a Barcelona cyst. He consulted with the gynecologist on call who wanted to remove the cyst the next morning under general anesthesia. We decided to wait and get a second opinion since we don't favor the idea of general anesthesia. He also prescribed wide spectrum antibiotic for one week because he said that the cyst look infected. The cyst is approximately two centimeters by one centimeter big and quite hard.

I can find no reference to a "Barcelona" cyst. Could you please give some more information and some advice? Thank you.

James

Dear James,

On either side of the vaginal opening is a pair of glands called the Bartholin's ("Barcelona" was close) or vestibular glands. The Bartholin's glands produce the fluid that lubricates the vulva's inner lips. Located on each side of the entrance into the vagina, this substance can ease penetration. If the opening to either of these glands becomes blocked (usually it’s only one of them at a time), a Bartholin's cyst may result. This cyst can make a bulge in the lip near the opening of the vagina. The cyst can also swell and become tender. The point at which the cyst becomes painful or doesn’t respond to at-home treatment is the time that medical attention may be necessary.

Some Bartholin's cysts may go unnoticed because they’re either quite small or aren’t painful. In that case, no treatment is typically required. If the cyst is noticeable and uncomfortable, it may respond to soaking in warm water about three to four times a day (for about 10 to 15 minutes each time). Doing this may help the cyst rupture and drain on its own. If a cyst becomes significantly painful (in your wife’s case) or doesn’t respond to do-it-yourself strategies within two to three days, it may be time to consult a health care provider.

If pain is associated with the cyst, it’s possible that the gland has not only become blocked, but also infected. Often times, the cause of the blockage is unknown. However, it seems that the blockage and associated infections may be due to bacterial sexually transmitted infections (STIs) or E.coli. If and when a Bartholin's cysts becomes infected, an abscess, or pus-filled pocket in the inflamed tissue, may result — which can be excruciatingly painful and may also cause a fever. At this stage, surgical drainage may be necessary. Essentially, an incision is made in the cyst and the pus and fluid is then allowed to drain out. A small tube called a catheter is then placed in the incision and left there for about six weeks to allow for complete drainage of the cyst. This procedure is usually done under local anesthesia or sedation. The good news is that pain typically goes away once the cyst has been drained. If cysts recur, another procedure called marsupialization may be utilized to create permanent, but tiny (less than a quarter inch) opening on either side of the cysts to help with drainage. For cysts that don't respond to these treatments, surgical removal may be advised (though it's rare).

There are a number of circumstances under which antibiotics would be prescribed for a Bartholin’s cyst. If a culture taken from the drainage is positive for infection or if a patient tests positive for an STI, antibiotics may be prescribed. Antibiotics may also be prescribed to folks who have recurring cysts or are at a higher risk for infection (e.g., pregnant women and those with compromised immune systems). However, it’s also possible that if the cyst or abscess is properly drained that antibiotics may not be necessary.

Unfortunately, Bartholin’s cysts themselves may not be preventable, but keeping up general hygiene and practicing safer sex (thereby decreasing the risk of STIs) may help reduce the likelihood that they’ll become infected.

Hope this helped a-“cyst” you in your understanding of the condition. As you and your wife decide how to address her medical issue, soaking in a warm bath may help alleviate her discomfort. Seeking further assistance from a health care provider can help her say sayonara to the cyst, once and for all.

Alice!

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