A Bartholin cyst that has caused no pain for years

Lack of pain suggests that there may be no active inflammation, yet location and appearance alone cannot reliably identify every vulval lump.

A Bartholin gland sits beside the vaginal opening and releases lubricating fluid through a small duct. When that duct is blocked, retained fluid can form a soft or firm swelling, often on one side. A cyst can stay quiet when it is not infected and is not pressing on sensitive tissue.

A clinician can check whether the lump is in the expected position and whether it has features that call for imaging, drainage, a sample, or another assessment. A new or unexplained vulval mass after menopause merits prompt clinical review even when it does not hurt.

Arrange a routine gynaecology or primary-care appointment if the lump has never been examined or if its diagnosis is uncertain. Note whether its size, firmness, skin colour, or position has changed. Do not squeeze, puncture, or try to drain it yourself, because this can injure tissue and introduce infection.

If an examined cyst remains small and causes no symptoms, observation may be reasonable. Treatment is considered when it interferes with sitting, walking, sex, or daily comfort, repeatedly becomes inflamed, or has uncertain features.

Seek prompt medical care if the lump becomes painful, rapidly enlarges, feels hot, turns red, drains pus, or is accompanied by fever or feeling unwell. These changes can occur when a cyst becomes infected or forms an abscess. Urgent assessment is also appropriate if severe pain makes walking or sitting difficult.

Ask whether the lump is in the typical Bartholin gland area, whether observation is suitable, and which changes should bring you back. If treatment is proposed, ask how drainage, marsupialisation, and gland removal differ for your situation and what recovery may involve.