Bartholin’s cyst – Treatment – NHS

If you have a lump in the opening of your vagina, get it checked by a GP.

If it turns out to be a Bartholin’s cyst and it does not bother you, it’s often better to leave it alone.

If the cyst is painful, a GP may recommend:

• soaking the cyst for 10 to 15 minutes in a few inches of warm water (it’s easier in the bath) – it’s best to do this several times a day for 3 or 4 days if possible
• holding a warm compress (a flannel or cotton wool warmed with hot water) against the area
• taking painkillers, such as paracetamol or ibuprofen

Always read the manufacturer’s instructions when using medicine you buy from a pharmacy or supermarket.

Treating an abscess

If the cyst becomes infected and an abscess (a painful collection of pus) develops, you may be prescribed antibiotics to clear the infection.

Once the infection has been treated, a GP may still recommend having the cyst drained, particularly if the abscess is large.

Draining cysts and abscesses

A number of techniques can be used to drain a Bartholin’s cyst or abscess and reduce the likelihood of it returning.

Balloon catheter insertion

Balloon catheter insertion, sometimes known as catheter placement or fistulisation, is a procedure used to drain the fluid from the abscess or cyst.

A permanent passage is created to drain away any fluid that builds up in the future. This is an outpatient procedure, which means you will not need to stay in hospital overnight.

It’s usually carried out under local anaesthetic, where you remain conscious, but the area is numbed so you cannot feel anything. It can also be carried out under general anaesthetic, where you’re unconscious and unable to feel anything.

A cut is made in the abscess or cyst and the fluid is drained. A balloon catheter is then inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.

Once inside the abscess or cyst, the balloon is filled with a small amount of salt water. This increases the size of the balloon so it fills the abscess or cyst. Stitches may be used to partially close the opening and hold the balloon catheter in place.

The catheter will stay in place while new cells grow around it (epithelialisation). This means the surface of the wound heals, but a drainage passage is left in place. 

Epithelialisation usually takes around 4 weeks, although it can take longer. After epithelialisation, the balloon will be drained and the catheter removed.

A few small studies have reported more than 8 out of 10 of women healed well and their cysts or abscesses did not return after balloon catheter insertion.

Possible complications of balloon catheter insertion include:

• pain while the catheter is in place
• pain or discomfort during sex
• swelling of the lips (labia) around the opening of the vagina
• infection
• bleeding
• scarring

Marsupialisation

If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used.

The cyst is first opened with a cut and the fluid is drained out. The edges of the skin are then stitched to create a small “kangaroo pouch”, which allows any further fluid to drain out.

When the procedure is complete, the treated area may be loosely packed with gauze to soak up fluid from the wound and stop any bleeding. This will usually be removed before you go home.

Marsupialisation takes about 10 to 15 minutes and is usually performed as a day case procedure, so you will not have to stay in hospital overnight. It’s usually carried out under general anaesthetic, although local anaesthetic can be used instead.

Although complications after marsupialisation are rare, they can include:

• infection
• the abscess returning
• bleeding
• pain – you may be given painkillers for the first 24 hours after the procedure

After marsupialisation, you’ll be advised to take things easy for a few days. You should avoid having sex until the wound has completely healed, which usually takes about 2 weeks.

Removing the Bartholin’s gland

Surgery to remove the affected Bartholin’s gland may be recommended if other treatments have not been effective and Bartholin’s cysts or abscesses keep coming back.

This operation is usually carried out under general anaesthetic and takes about an hour to complete. You may need to stay in hospital for 2 or 3 days afterwards.

Risks of this type of surgery include bleeding, bruising and infection of the wound. If the wound does become infected, this can usually be treated with antibiotics prescribed by a GP.

Alternative procedures

There are a number of alternative ways of treating a Bartholin’s cyst, but they’re less commonly used or are not widely available.

Silver nitrate gland ablation

Silver nitrate is a mixture of chemicals sometimes used to burn (cauterise) blood vessels to stop bleeding.  A small, solid stick of silver nitrate is used in silver nitrate gland ablation.

A cut is made in the skin surrounding the vagina and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the empty space left after draining the fluid.

The silver nitrate causes the cyst cavity to form into a small, solid lump. After 2 or 3 days the silver nitrate and cyst remains are removed or may fall out on their own.

It’s possible for the silver nitrate to burn some of the skin of the vulva when it’s first used. One small study reported this occurs in about 1 in 5 of those who receive this treatment.

Carbon dioxide laser

A carbon dioxide laser can be used to create an opening in the skin of the vulva so the cyst can be drained.

The cyst can then be removed, destroyed using the laser, or left in place with a small hole to allow fluid to drain from it.

Needle aspiration

During needle aspiration, a needle and syringe are used to drain the cyst. It is sometimes combined with a procedure called alcohol sclerotherapy, where the cavity is filled with a 70% alcohol liquid after being drained. This is left in the cyst cavity for 5 minutes and then drained out.

Advice after surgery

To help the wound heal and reduce the risk of infection after surgery, you may be advised to avoid:

• having sex and using tampons for up to 4 weeks
• using perfumed bath products for up to 4 weeks
• driving or performing tasks that need careful attention for 24 to 48 hours after having a general anaesthetic

Page last reviewed: 26 October 2021
Next review due: 26 October 2024

Bartholin cyst or abscess Information | Mount Sinai

Abscess – Bartholin; Infected Bartholin gland

Bartholin abscess is the buildup of pus that forms a lump (swelling) in one of the Bartholin glands. These glands are found on each side of the vaginal opening.

External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

Bartholin glands are found on each side of the vaginal opening. A Bartholin cyst is a buildup of fluid that occurs if the opening of the gland is blocked. A Bartholin abscess may occur if the cyst fluid becomes infected. The Bartholin cyst or abscess appears as a lump or swelling on the side of the vaginal opening.

Causes

A Bartholin abscess forms when a small opening (duct) from the gland gets blocked. Fluid in the gland builds up and may become infected. Fluid may build up over many years before an abscess occurs.

Often the abscess appears quickly over several days. The area will become very hot and swollen. Activity that puts pressure on the vulva, and walking and sitting, may cause severe pain.

Symptoms

Symptoms may include:

• A tender lump on either side of the vaginal opening
• Swelling and redness
• Pain with sitting or walking
• Fever, in people with low immunity
• Pain with sexual intercourse
• Vaginal discharge
• Vaginal pressure

Exams and Tests

The health care provider will do a pelvic exam. The Bartholin gland will be enlarged and tender. In rare cases, a biopsy may be suggested in older women to look for a tumor.

Any vaginal discharge or fluid drainage will be sent to a lab for testing.

Treatment

SELF-CARE STEPS

Soaking in warm water 4 times a day for several days can ease the discomfort. It can also help the abscess open and drain on its own. However, the opening is often very small and closes quickly. Therefore, the abscess often returns.

DRAINAGE OF THE ABSCESS

A small surgical cut can completely drain the abscess. This relieves symptoms and provides the fastest recovery.

• The procedure can be done under local anesthesia in a provider’s office.
• A 1 to 2 cm cut is made at the site of abscess. The cavity is irrigated with normal saline. A catheter (tube) may be inserted and left in place for 4 to 6 weeks. This allows continuous drainage while the area heals. Sutures are not required.
• You should begin soaking in warm water 1 to 2 days afterward. You cannot have sexual intercourse until the catheter is removed.

You may be asked to have antibiotics if there is pus or other signs of infection.

MARSUPIALIZATION

Women can also be treated with a minor surgery called marsupialization.

• The procedure involves creating an elliptical opening along the cyst to help the gland drain. The abscess is removed. The provider places stitches at the edges of the cyst.
• The procedure can sometimes be done in the clinic with medicine to numb the area. In other cases, it may need to be done in the hospital with general anesthesia so that you are asleep and pain-free.
• You should begin soaking in warm water 1 to 2 days afterward. You cannot have sexual intercourse for 4 weeks after surgery.
• You can use oral pain medicines after the procedure. Your provider may prescribe narcotic pain medicines if you need them.

EXCISION

Your provider may recommend that the glands be completely removed if abscesses keep coming back.

• The procedure involves surgical removal of the entire cyst wall.
• Generally performed in the hospital under general anesthesia.
• You cannot have sexual intercourse for 4 weeks after surgery.

Outlook (Prognosis)

The chance of a full recovery is excellent. The abscesses may return in few cases.

It is important to treat any vaginal infection that is diagnosed at the same time as the abscess.

When to Contact a Medical Professional

Call your provider if:

• You notice a painful, swollen lump on the labia near the vagina opening and it does not improve with 2 to 3 days of home treatment.
• Pain is severe and interferes with your normal activity.
• You have one of these cysts and develop a fever higher than 100.4°F (38°C).

Ambrose G, Berlin D. Incision and drainage. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 37.

Dolan MS, Hill C, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Smith RP. Bartholin gland cyst/abscess drainage. In: Smith RP, ed. Netter’s Obstetrics and Gynecology. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 251.

Tuggy ML. Bartholin cyst and abscess: word catheter insertion marsupialization. In: Fowler GC, ed. Pfenninger and Fowler’s Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 118.

Last reviewed on: 4/19/2022

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

symptoms, diagnosis, treatment of bartholinitis, cysts or abscess of the Bartholin gland – Department of Gynecology – State Hospital NCC No. 2 (CCH RAS)

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Bartholinitis (abscess of the Bartholin’s gland, Bartholin’s cyst) – a disease in which the Bartholin’s glands become inflamed. These glands are located on both sides of the vagina in the region of the labia minora (on the eve of the vagina). Their main function is to maintain the moisture of the entrance to the vagina during intercourse. The excretory ducts of the glands open to the surface of the labia minora. When the ducts are infected (sexually transmitted infections – gonorrhea, trichomoniasis and chlamydia, less often – gonococci, streptococci, staphylococci, Escherichia coli and other microorganisms), their inflammation occurs, which can later spread to the entire gland and surrounding tissues. In most cases, only one gland becomes inflamed, i.e. the inflammatory process is unilateral.

Causes of development of bartholinitis – infection through the excretory ducts of the Bartholin glands. It contributes to:

• Poor hygiene of the genitals;
• Unprotected sex;
• Sexual contact during menstruation;
• The presence of diseases such as colpitis, urethritis, the presence of sexually transmitted diseases;
• Reduced immunity.

Symptoms of acute bartholinitis

• Swelling and redness on the labia minora;
• Appearance of a lump on the labia minora; compaction is painful when pressed;
• Swelling and hardening of the labia majora on the side of inflammation;
• Discomfort and pain in the labia while walking, intercourse, contact with clothing;
• Fever;
• Enlargement of lymph nodes in the groin.

Bartholinite forms

Depending on the volume and localization of the affected area, such forms of bartholinitis are distinguished as:

Canaliculitis – the infection got into the excretory duct of the gland and caused its inflammation, there are no pronounced symptoms

Bartholin’s gland cyst – with a clogged excretory canal, the secretion of the gland accumulates in the formed cavity due to the lack of outflow, there is no suppuration of the tissues of the gland itself and the surrounding tissue.

Abscess of Bartholin’s gland – tissues of Bartholin’s gland and surrounding cellular tissue are involved in the inflammatory process.

Chronic bartholinitis

In the chronic form, the disease periodically worsens under the influence of factors such as hypothermia, decreased immunity, menstruation, etc. Outside of exacerbation, mild pain from the affected gland, discomfort during intercourse may appear. During the period of exacerbation, symptoms similar to those of acute bartholinitis occur.

Diagnosis of bartholinitis

Diagnosis is based on examination data. At the same time, to select the most effective treatment, the doctor may prescribe such studies as a general blood test, urine; examination for urogenital infections, laboratory examination of the secretion of the Bartholin gland or pathological discharge from it, and others.

Treatment of bartholinitis

In most cases, after determining the cause that caused the development of bartholinitis, antibacterial therapy is selected taking into account the sensitivity of microorganisms to antibiotics, the inflamed area is treated with antiseptic agents, and a course of physiotherapy can be prescribed.

Treatment of an abscess of the Bartholin gland is predominantly surgical – an opening, drainage and treatment of the cavity is performed, if necessary, drug therapy is prescribed. Gynecologists at the NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) will select the most effective and quick treatment for bartholinitis. Treatment of a Bartholin gland cyst is also mainly surgical, outside the period of exacerbation.

Removal of cysts of Bartholin’s gland and Opening of abscess of Bartholin’s gland is possible in a day hospital (without daily hospitalization).

Drainage of abscesses of the female genital organs

The most common localization of abscesses in the vulva is an abscess of the Bartholin gland. Inflammation of the Bartholin’s gland leading to an abscess is most often the result of a gonorrheal infection. Gonorrheal inflammation affects almost exclusively the excretory duct of the gland; the gland itself remains unaffected. The inflamed excretory duct is filled with pus, its opening swells and sticks together, as a result of which the pus cannot pour out. The accumulated pus stretches the excretory duct of the gland and turns it into a false abscess. Suppuration usually does not occur in the surrounding connective tissue. If pyogenic microorganisms join the gonococci, then the gland itself can fester, and then a true abscess of the Bartholin gland is formed. The disease occurs when infectious agents enter the Bartholin gland. The most common are sexually transmitted diseases: gonorrhea, trichomoniasis, chlamydia.

There are also bartholinitis caused by other pathogens:

• staphylococci,
• streptococci,
• E. coli,
• candida
• and others.

However, most often the disease is caused by an association of two or three infections. As a rule, pathogens enter the duct of the Bartholin gland from the urethra or vagina during urethritis and / or colpitis. However, sometimes it is possible for an infection to enter directly into the gland itself with a blood or lymph flow. Non-compliance with the rules of personal hygiene (especially during menstruation) contributes to the infection entering directly into the duct of the gland. “for infection. Wearing tight underwear disrupts the normal outflow of gland secretions, so it stagnates, creating ideal conditions for a pathogen to enter the gland duct. A promiscuous sex life at times increases the likelihood of infection with sexually transmitted diseases. The presence of foci of chronic infection (caries) in the body , pyelonephritis). In this case, pathogens enter the Bartholin’s gland with blood or lymph flow. Impairment of the immune system, general or local hypothermia, lack of vitamins leads to a decrease in protective factors in the body. This contributes to the entry of infectious agents both directly into the gland itself and into its duct. Surgical interventions on the urogenital area (for example, abortion) performed in violation of health standards during manipulation, as well as with non-compliance with the rules of the postoperative period.

Types and symptoms

The disease begins acutely: there is severe pain in the region of the labia majora, in which an abscess has developed. The pain intensifies when walking, sitting, during intercourse and passing stools. The body temperature rises to 38-39 ° C, fatigue, weakness and chills appear. There is swelling of the labia majora on the side of the lesion. Moreover, sometimes it is so pronounced that it closes the entrance to the vagina. The appearance of a fluctuation (softening of the swelling) indicates that a true abscess of the Bartholin gland has developed, and a purulent capsule has formed in its cavity. The woman’s condition worsens: the body temperature rises to 40 ° C, phenomena of intoxication (weakness, chills, headache). Pain in the region of the labia majora, in which the cyst has formed, intensifies, acquiring the character of a constant pulsating.

Local changes

Severe swelling (edema) of the labia majora on the side of the lesion, which sometimes reaches up to 5-7 cm in diameter. The abscess can open on its own. At the same time, the general condition of the woman improves: the body temperature drops, swelling and pain decrease.

Diagnosis

Recognition of a typical false abscess is not difficult. An abscess differs from a Bartholin gland cyst in pain and soreness when palpated, redness in the area of ​​​​the opening of the excretory duct of the gland. This redness is often accompanied by swelling of the skin. Furuncles, sometimes localized in this area, rarely reach such a size as an abscess of the Bartholin gland; in addition, boils lie more superficially. With a hematoma, which has a characteristic color and is the result of an injury, as evidenced by anamnestic data, it is, of course, difficult to mix an abscess. In the same way, it is difficult to mistake a hernia of the pudendal lip for an abscess of the Bartholin’s gland.

Treatment

Abscess opening technique. The preparation of the operating field is normal. The hair on the external genital organs is shaved, the vagina is washed with some disinfectant solution (potassium permanganate solution, etc. ) and, in order to avoid contamination with pus, it is tamponed with a strip of sterilized gauze. For anesthesia, we usually use ether or chloroethyl stunning. The incision area is smeared with iodine tincture. The incision should be made large and brought to the lower pole of the abscess, otherwise pockets will remain in which pus will accumulate, resulting in a purulent fistula that does not heal for a long time. The incision is made in the place of the clearest fluctuation, where the tissue covering the abscess is most thinned. After the pus has flowed out, the abscess cavity is sprinkled with white streptocide or wiped with a small tupfer moistened with iodine tincture; then a strip of gauze or a thin rubber tube is inserted into the cavity so that the hole does not close prematurely. At the end of the operation, the end of the gauze strip is removed, and a day later it is completely removed. A gauze and cotton pad is placed in front of the vulva to absorb the pus flowing from the wound.