” She noticed a right – sided swelling on her vulva about 3 months prior to when she showed up at the clinic”

Emobileclinic Trending Topic

She noticed a right – sided swelling on her vulva about 3 months prior to when she showed up at the clinic. The swelling was not painful and had being increasing in size gradually. The swelling disturbed her walking. There was no associated fever or discharge. There was no dysuria, frequency nor urgency . She was a young lady who walked into the consulting room unhappy. She was not pale, aferbrile and not jaundiced. There was no peripheral lymph node enlargement. She was not married and attained menarche at 15 years of age. She menstruated for 4 to 5 days in a cycle of 28 to 30 days. She was nulliparous. What could be wrong with her?

A. Ovarian Cyct
B. Uterine Fibroids
C. Uterovaginal prolapse
D. Bartholin’s cyst
The answer is D. Bartholin’s cyst

About 2% of adult women develop cyst or abscess swelling of the Bartholin’s gland. The main causes of obstruction are infections and post traumatic fibrosis. e. g following mediolateral episiotomy and posterior colporrhaphy, inspissated mucus and congenital narrowing of the cyst. Rarely, enlargement may result from adenocarcinoma of Bartholin ‘s gland and this should be suspected in women over 40 years of age. In the case of our patient, upon pelvic examination, there was a cystic swelling of the right labium, particularly obstructing the vaginal orifice. It measured about 4cm by 5cm. Hymen was intact. A surgery was needed and she agreed to Marsupialisation of Bartholin’s cyst.

Bartholin’s gland, also known as greater vestibular gland is a pea sized compound lobulated racemose structure lined by columnar epithelium, lying posterolaterally on either side of the vaginal orifice. Each gland drains by a duct about 5mm in diameter and 2-3cm long, opening into the vestibule between hymen and ipsilateral labium minus at 5 and 7 .O clock.
Bartholin’s cyst is usually a dilatation of the duct of the Bartholin’s gland following obstruction at its opening. Most are sterile but if it contains prulent material, it is termed Bartholin’s abscess.
Cyst and abscess are common between menarche and menopause, but not necessarily associated with sexually activity. Our patient for instance was not sexually active. The common clinical features are those swelling, local pain, and tenderness, superficial dyspareunia, and vulva discomfort with painful physical activities including walking. Simple and uncomplicated cysts are generally small and asymptomatic.
The treatment modalities for Bartholin ‘s abscess and cyst include marsupialisation ,word catheraization,cyct excision as well as simple warm sitz bath for cysts that rupture spontaneously. The aim of the treatment is for the preservation of the gland and it’s function and also prevention of re-occurence. Our patient was treated by marsupialisation, antibiotic therapy as well as post operative sitz baths. The surgery procedure is very simple and very effective as it is associated with minimum morbidity and blood loss. Most importantly it preserves gland function and is association with low risk of occurrence of about 2.8%. In older women exercised edges of the cyst should be sent for historical examination to exclude the rare carcinoma of the ducts or glad.

Word catheraization involves insertion of word catheter into the cavity of the cyst and inflating the bulb with 2-3mls of water .The free end of the catheter is tucked into the vaginal and the entire catheter left in situ for 4 weeks during which a new tract forms along the catheter. The disadvantage is that the catheter is not widely available and there is a higher cyct recurrence rate than that following marsupiation.
Cyst excision is recommended for cases recurring after several episode of marsupialisation or word catheterization and also in women over 40 years. It is however has a higher risk of bleeding, infection and subsequent development of dyspareunia. Other mode of treatment include,incision and drainage, aspiration,cuttage of the abscess cavity and applications of silver nitrate to the cyst cavity. There was no recurrence after Marsupialisation in so many studies but it does re occur in laser vaporization which is a very expensive way to treat this. It has a recurrence rate of 11%.
Antibiotics and analgesic are important in the management. After the surgery, our patient was given a course of prophylactic antibiotics as well as analgesics. She was encourage to do regular sitz baths for relative of pain and discomfort.