Treatment Options for Bartholin Cyst
The primary treatment options for Bartholin cysts include observation for asymptomatic cysts, while symptomatic or infected cysts (abscesses) larger than 2 cm should be drained as they typically do not resolve spontaneously and tend to recur. 1
Asymptomatic Cysts
- Many Bartholin duct cysts that are not infected remain asymptomatic and resolve spontaneously without intervention 1
- Observation is appropriate for small, asymptomatic cysts 1
Symptomatic or Infected Cysts (Abscesses)
Indications for Drainage
- Infected cysts or abscesses larger than 2 cm should be drained 1
- Painful cysts that interfere with daily activities require intervention 1
Treatment Options
1. Word Catheter Placement
- Most frequently employed technique for office and emergency department management 2
- Involves creating a small incision and placing a catheter that remains in place for 4-6 weeks to create an epithelialized tract 2
- Advantages: Office-based procedure, shorter time from diagnosis to treatment (approximately 1 hour) 3
- Disadvantages: May dislodge before epithelialization, leading to recurrence; not always available in all settings 2
2. Marsupialization
- Surgical technique that creates a permanent opening by suturing the cyst wall to surrounding tissue 3
- Comparable recurrence rates to Word catheter (10% vs 12%) 3
- Disadvantages: Requires more time to perform (approximately 4 hours from diagnosis to treatment), higher use of analgesics in first 24 hours after treatment (74% vs 33% for Word catheter) 3
3. Alternative Drainage Techniques
- Novel techniques using plastic tubing loops have been developed as alternatives to Word catheters 2
- These techniques allow drainage while preventing premature closure of the drainage tract 2
4. Surgical Excision
- Reserved for recurrent cysts or when there is concern for malignancy 4
- More invasive procedure that may require general anesthesia 4
- Not typically first-line treatment due to increased risk of complications 4
5. Other Treatment Options
Adjunctive Therapy
- Antibiotics may be prescribed when there are signs of cellulitis or systemic infection 5
- Analgesics for pain management 3
Treatment Selection Considerations
- Size and symptoms of the cyst/abscess 1
- Presence of infection 1
- Patient preference and comfort 1
- Available resources and provider experience 2
- History of recurrence 4
Outcomes and Follow-up
- Both Word catheter and marsupialization have comparable recurrence rates (approximately 10-12%) 3
- Follow-up is recommended to ensure complete resolution and to monitor for recurrence 1
Pitfalls and Caveats
- Simple lancing without creating a permanent drainage pathway often leads to recurrence 6
- Recurrent cysts may require more definitive surgical management 4
- Bartholin gland carcinoma should be considered in women over 40 years with a Bartholin mass, particularly if it is firm or fixed 4
- Failure to differentiate between a simple cyst and an abscess may lead to inappropriate treatment selection 4