The results of our study suggest that in this sample of asymptomatic women volunteering for research studies involving pelvic imaging, approximately 1 in 30 will have a Bartholin gland cyst identified. This is slightly higher than the published prevalence of 2%.4
As our data are from a pooled secondary analysis of case-control studies, rather than results from a population-based cross-sectional study, we cannot assert that the true prevalence of Bartholin gland cysts is 3.3%. Our findings are similar, though, to those of Gousse and colleagues, who identified incidental Bartholin gland cysts in four out of 100 women undergoing pelvic MRI.8
However, the women in the study by Gousse, et al., were having imaging performed for clinical reasons, and so may not be representative of an asymptomatic, healthy population. Given that recent epidemiologic studies have not been published, our data suggest that it may be reasonable to raise the estimate of the occurrence of Bartholin gland cysts.
Imaging is increasingly being used as part of diagnostic evaluations.9, 10
There are therefore reports of several gynecologic findings which are becoming more frequently identified incidentally, such as adnexal masses, endometrial fluid collections, and other endometrial abnormalities in asymptomatic postmenopausal women.11–16
Bartholin gland cysts are readily identifiable with routine imaging modalities.1, 17–20
We therefore predict that the incidental detection of Bartholin gland cysts, like the gynecologic conditions noted above, will occur with growing frequency. Radiologists and gynecologic providers must be informed that these cysts are relatively common and generally benign.21
It is commonly taught that Bartholin gland cysts in postmenopausal women are abnormal and should raise a higher index of suspicion for malignancy.22
By contrast, we find that the age distribution and self-reported menopausal status of participants with Bartholin gland cysts are similar to that of women without visible cysts. Furthermore, our population of women with visible cysts can be almost equally stratified into groups older than 50 years of age and younger than 50 years old. Considerations regarding potential malignancy would therefore be better if based on the changing occurrence of the disease with age. We endorse the notion that clinical evaluation may be more meaningful than strict algorithms based solely on patients’ age and/or menopausal status.23
There are several strengths to this study, including the wide range of ages, use of asymptomatic volunteers as research participants, inclusion of information on parity, and the use of high resolution MRI. We must also acknowledge several limitations, including the relative racial homogeneity of our participants which may limit generalizability, the lack of data about whether the participants were aware of and/or symptomatic from their cysts, as well as the lack of long-term follow-up data about the participants. Although these participants were recruited from the community as healthy volunteers, it is possible that gynecologic symptoms, including those from Bartholin gland cysts, may have motivated some of these women to volunteer, leading to a selection bias. As described earlier, our study design also precludes calculation of the true population prevalence.
In conclusion, Bartholin gland cysts may be visualized on pelvic magnetic resonance imaging with reasonably high frequency. We must stress, however, that the incidentally-identified Bartholin gland cyst is a relatively new gynecologic entity. Given our lack of knowledge about the natural history of these lesions, further research is necessary to determine how they should be managed clinically.