What is the treatment for a Bartholin cyst?

Treatment of Bartholin Cysts and Abscesses

The most effective treatments for Bartholin cysts and abscesses are Word catheter placement or marsupialisation, both of which have comparable recurrence rates of approximately 10-12%. 1

Understanding Bartholin Cysts

• Bartholin glands are located at the 4 and 8 o'clock positions of the vaginal opening, and when infected, present with swelling, erythema, and tenderness that can extend into the labia minora 2
• Diagnosis is primarily clinical, based on physical examination showing a tender, fluctuant mass at the vaginal introitus 2

Treatment Options

First-line Treatments:

• Word catheter placement:

  • An office-based procedure that involves creating a small incision and placing a catheter with an inflatable balloon tip 3
  • Advantages: Can be performed in approximately 1 hour, requires less post-procedure analgesia (33% of patients), and costs approximately €216 (significantly less than surgical alternatives) 1, 3
  • The catheter should remain in place for 4-6 weeks to allow epithelialization of the drainage tract 3
  • Success rate of approximately 87% with recurrence rates of only 3.8% 3

• Marsupialisation:

  • Creates a permanent opening by suturing the cyst wall to the surrounding tissue 1
  • Takes longer to perform (approximately 4 hours from diagnosis to treatment) 1
  • Higher post-procedure analgesic requirements (74% of patients) 1
  • Costs approximately €1282-1584 (about seven times higher than Word catheter) 3
  • Recurrence rate of approximately 10% 1

Alternative Treatments:

• Novel catheter techniques: Using small loops of plastic tubing as an alternative when Word catheters are unavailable 4
• Silver nitrate application: Less commonly used but mentioned in literature 5
• Surgical excision: Reserved for recurrent cases or when malignancy is suspected 5

Antibiotic Therapy

• Antibiotics should be prescribed when there are signs of cellulitis, systemic infection, or extensive inflammation 6, 2
• Appropriate antibiotic options for perineal infections include:
  • Metronidazole
  • Ciprofloxacin
  • Levofloxacin
  • Ceftriaxone 2

Treatment Algorithm

1. For asymptomatic small cysts:

   • Observation may be appropriate 7

2. For symptomatic cysts or abscesses:

   • First choice: Word catheter placement (office-based procedure with lowest recurrence and cost) 1, 3
   • Alternative: Marsupialisation if Word catheter unavailable or not feasible 1

3. For cases with signs of cellulitis or systemic infection:

   • Add appropriate antibiotics to the above treatments 6, 2

4. For recurrent cases:

   • Consider surgical excision of the Bartholin gland 5

Common Pitfalls to Avoid

• Simple incision and drainage without catheter placement or marsupialisation leads to high recurrence rates 7
• Failure to recognize signs of systemic infection requiring antibiotics 2
• Premature removal of Word catheter before epithelialization of the drainage tract (ideally should remain for 4 weeks) 3
• Failure to consider malignancy in older women with Bartholin gland enlargement 5