What is the treatment for a Bartholin's cyst?

Treatment of Bartholin's Cysts

Infected Bartholin's cysts or abscesses larger than 2 cm require drainage as they rarely resolve spontaneously, with Word catheter placement or marsupialization being the preferred first-line treatments. 1

Diagnosis and Evaluation

• Bartholin glands are located in the posterior vestibule at the 4 and 8 o'clock positions
• When infected, they present with swelling, erythema, and tenderness that can extend into the entire labia minora
• Special consideration for women over 40 years:
  • Malignancy should be considered in the differential diagnosis
  • Closer evaluation is warranted to rule out Bartholin gland adenocarcinoma 1

Treatment Options

Asymptomatic Cysts

• Many uninfected Bartholin duct cysts remain asymptomatic and resolve spontaneously without intervention 2

Symptomatic or Infected Cysts/Abscesses

For cysts/abscesses larger than 2 cm, drainage is indicated as they rarely resolve spontaneously and tend to recur 1, 2

1. Word Catheter Placement (preferred office-based procedure)

   • Involves creating a small incision and placing a catheter with an inflatable balloon tip
   • Catheter should remain in place for 4-6 weeks to allow epithelialization of the drainage tract
   • Advantages: shorter procedure time, lower analgesic use 1
   • Alternative: If Word catheter is unavailable, a simple loop of plastic tubing can be used 3

2. Marsupialization

   • Creates a permanent opening by suturing the cyst wall to the surrounding tissue
   • Advantages: more definitive for recurrent cysts
   • Disadvantages: longer procedure time, higher analgesic use 1
   • Recurrence rates are comparable to Word catheter placement 1

3. Complete Excision

   • Consider once infection resolves to prevent recurrence
   • Particularly recommended for women over 40 years to rule out malignancy 1
   • Most widely used treatment for non-infected cysts in some settings (68.5% of cases) 4

Antibiotic Use

• Systemic antibiotics are not routinely required for simple drainage procedures
• Consider antibiotics in cases with:
  • Extensive surrounding cellulitis
  • Systemic manifestations (fever, elevated WBC)
  • Immunocompromised patients
  • Multiple lesions 1

Post-Procedure Care

• Cover the wound with a dry dressing
• Avoid frequent dressing changes to prevent cross-infection
• Schedule follow-up to ensure proper healing and assess for recurrence 1

Special Considerations

• For severe infections with risk of sepsis or rectovaginal fistula, more aggressive management may be required
• A systematic review found no single surgical intervention was clearly superior for treating symptomatic Bartholin's cysts or abscesses 5
• Recurrence is a common issue with all treatment methods

Treatment Algorithm

1. Asymptomatic, small cyst: Observation
2. Symptomatic or infected cyst/abscess >2cm:
   • First-line: Word catheter placement or marsupialization
   • For recurrent cases: Consider marsupialization or complete excision
   • For women >40 years: Consider complete excision to rule out malignancy
3. Severe infection: Add systemic antibiotics and consider more aggressive surgical management

By following this evidence-based approach, most Bartholin's cysts and abscesses can be effectively managed with good outcomes and minimal complications.