History and exam

Key diagnostic factors

common

vulval/perineal mass

Classically a medially protruding cystic structure at the inferior aspect of the labia majora in the 5 or 7 o'clock position. It is crossed by the labium minus. Occasionally, cysts spread into the labium majus.[2][Figure caption and citation for the preceding image starts]: Bartholin cystFrom the personal collection of Colleen Kennedy Stockdale [Citation ends].com.bmj.content.model.Caption@4fbe423f

vulval pressure or fullness

Cysts may create a pressure phenomenon at the introitus.[2] While small cysts may be asymptomatic, women note the presence of fullness or pressure with increasing size.

pain during sitting or walking

Larger cysts are more likely to cause discomfort, and pain may be noted when sitting or walking. Pain can be particularly severe with abscess formation.[18]

Other diagnostic factors

common

fever

About 25% of women with abscess have fever.[15]

dyspareunia

With increasing cyst size, women note increasing symptoms. Larger cysts protrude medially, obscuring the introitus, and this may result in painful sexual activity.[2]

vulval erythema and induration

The most severely symptomatic patients present with evidence of infection or abscess formation.

uncommon

spontaneous rupture

Abscesses develop rapidly (within 2-3 days) and tend to rupture spontaneously.[6] Evidence of drainage and relief of pain suggest spontaneous rupture has occurred.

Risk factors

strong

woman of reproductive age

Most cysts occur in reproductive-age women between ages 20 and 50 years. Incidence decreases significantly after the menopause.[8][10]

previous Bartholin cyst/abscess

A risk factor especially if the initial treatment was incomplete (e.g., if a Word catheter dislodges before complete epithelialization). Repetitive procedures may also result in further duct orifice narrowing and scarring, making recurrence more likely.

sexual activity

Cyst size depends on accumulation of gland secretions and is exemplified by rapid enlargement during sexual activity and shrinkage or stability of cyst size in women with diminished sexual activity.

weak

direct trauma or surgery

Rarely, cyst or abscess may occur after episiotomy, trauma, or vulvovaginal surgery.

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