A Bartholin cyst is a fluid-filled lump that forms near the opening of the vagina when one of the Bartholin glands gets blocked. These cysts are common, typically painless, and often go unnoticed until they grow large enough to feel. Most are harmless on their own, but they can become infected and turn into a painful abscess that needs medical attention.
Where Bartholin Glands Are and What They Do
The Bartholin glands are two small, pea-sized glands located on either side of the vaginal opening, roughly at the 4 o’clock and 8 o’clock positions. Each gland drains through a narrow duct about 2.5 cm long that empties into the tissue just inside the labia. These glands become active at puberty, and their job is simple: they secrete small amounts of mucus that help keep the vaginal opening moisturized.
You can’t normally see or feel these glands. They only become noticeable when something goes wrong with the duct that carries their fluid out.
How a Cyst Forms
A Bartholin cyst develops when the opening of one of those small ducts gets blocked. With the exit sealed off, the mucus the gland keeps producing has nowhere to go. It backs up, and the duct swells into a fluid-filled sac. The blockage can happen because of minor injury, irritation, or infection, but in many cases the exact trigger is never identified.
The cyst itself contains the same clear, slippery mucus the gland normally produces. It can stay small for months or grow to the size of a marble, a golf ball, or occasionally larger. Growth tends to be gradual, and many people first notice it as a soft, round lump on one side of the vaginal opening.
Symptoms of a Simple Cyst
Small Bartholin cysts often cause no symptoms at all. You might discover one during a routine exam or while bathing. As a cyst gets larger, it can create a feeling of pressure or fullness on one side of the vulva. Sitting, walking, or sexual intercourse may become uncomfortable depending on the size and position of the lump. The cyst itself is usually not painful to touch and the overlying skin looks normal.
When a Cyst Becomes an Abscess
The situation changes significantly if the trapped fluid becomes infected. An infected Bartholin cyst turns into an abscess, and the difference is hard to miss. Where a simple cyst feels like a soft, painless bump, an abscess is tender, swollen, red, and often intensely painful. The pain can be bad enough to make sitting or walking difficult.
Other signs that a cyst has progressed to an abscess include:
- Warmth and redness over the lump
- Pain that worsens over hours or days
- Fever above 100.4°F (38°C)
- Vaginal discharge
- Pain during sexual intercourse
The bacteria involved are usually the common types that live on skin or in the digestive tract. Sexually transmitted infections can also be a cause, which is why doctors sometimes test the fluid drained from an abscess to identify the specific organism.
Home Care With Sitz Baths
For a small, mildly uncomfortable cyst, warm sitz baths are the standard first step. You fill a bathtub or a sitz bath basin with a few inches of warm water (around 104°F or 40°C) and soak for 15 to 20 minutes. Doing this three to four times a day for several days can sometimes encourage the blocked duct to open on its own, allowing the fluid to drain and the cyst to resolve.
If the cyst doesn’t improve after two to three days of consistent sitz baths, or if pain is worsening and interfering with daily activities, it’s time for a medical evaluation. Home treatment is reasonable for mild symptoms, but an abscess generally won’t resolve without a procedure.
Medical Procedures for Drainage
When a Bartholin cyst or abscess needs more than home care, the most common approach is a minor office procedure using a device called a Word catheter. After numbing the area with local anesthetic, a doctor makes a small incision into the cyst to release the trapped fluid. A thin, flexible tube with a tiny balloon on its tip is then inserted into the opening. The balloon is inflated with a few milliliters of sterile fluid to hold it in place.
The catheter stays in for up to four weeks. During that time, new tissue forms around the opening, creating a permanent drainage channel so the gland can function normally without fluid building up again. You can go about your regular activities with the catheter in place, though you’ll have a follow-up appointment to have it deflated and removed.
Marsupialization
If cysts keep coming back despite catheter treatment, or if the cyst is extremely large or painful, a surgical option called marsupialization may be recommended. In this procedure, a doctor opens the cyst, drains it, and then stitches the edges of the cyst wall to the surrounding skin. This creates a small, permanent pouch that allows the gland to drain freely. Recurrence rates after marsupialization are relatively low, ranging from 2% to 13%.
Cysts in Women Over 40
Bartholin cysts are most common in women of reproductive age. When a new Bartholin mass appears in someone who is postmenopausal or over 40, doctors take a more cautious approach. The Mayo Clinic notes that a biopsy is typically recommended in these cases to rule out Bartholin gland carcinoma, a rare cancer that can mimic the appearance of a benign cyst. This doesn’t mean every lump in this age group is cancerous, but it does mean it warrants a closer look rather than watchful waiting.
Recurrence and What to Expect Long Term
Bartholin cysts can come back, sometimes on the same side, sometimes on the other. There’s no reliable way to prevent them since the underlying cause of duct blockage isn’t always clear. Some people have a single episode that resolves and never returns. Others deal with repeated cysts over months or years, which is when doctors typically recommend marsupialization or, in rare and persistent cases, removal of the entire gland.
Most Bartholin cysts are more of a nuisance than a serious health problem. The key distinction to watch for is the shift from a painless lump to a red, hot, worsening swelling, which signals infection and the need for prompt treatment rather than continued home care.