Treatment of Bartholin's Cyst
For symptomatic Bartholin's cysts or abscesses, drainage with Word catheter placement or marsupialization should be performed rather than simple aspiration alone, as simple lancing results in high recurrence rates. 1
Initial Assessment and Triage
Asymptomatic cysts (<2 cm):
- Expectant management with observation is appropriate, as many resolve spontaneously without intervention 2
- No drainage procedure is required 2
Symptomatic cysts or abscesses (>2 cm):
- Require drainage as they do not resolve spontaneously and will recur without intervention 2
- Simple incision and drainage alone should be avoided due to high recurrence rates 1
Primary Treatment Options
Word Catheter Placement (First-Line for Office/ED Setting)
This is the most frequently employed and cost-effective technique: 3, 4
- Success rate: 87% with recurrence rate of only 3.8% 4
- Procedure: After local anesthesia, make a small incision, drain the cyst/abscess, and insert the Word catheter with the balloon inflated inside the cavity 1
- Duration: Leave catheter in place for 4 weeks to allow epithelialization of a drainage tract 1, 4
- Ease of use: Application difficulty score of 2/10, removal difficulty of 1/10 4
- Cost advantage: €216 compared to €1,282-1,584 for surgical marsupialization (7 times less expensive) 4
Common pitfall: The catheter may dislodge before epithelialization is complete (occurs in 37% of cases at mean 19 days), but this does not necessarily lead to recurrence 3, 4
Alternative if Word catheter unavailable: A loop of plastic tubing can be secured as a substitute drainage device 3
Marsupialization (Alternative Surgical Option)
- Can be performed in office setting under local anesthesia 1
- Creates a permanent opening by suturing the cyst wall edges to the surrounding skin 5
- More invasive than Word catheter but may be preferred for recurrent cases 5
Other Surgical Options
- Silver nitrate application: Alternative office-based procedure 5
- CO2 laser cauterization: Available but less commonly used 5
- Complete excision: Reserved for recurrent cases or concern for malignancy; requires general anesthesia and has higher morbidity 5
Adjunctive Medical Management
Antibiotics are indicated only when: 6
- Signs of surrounding cellulitis are present
- Evidence of systemic infection exists
- Antibiotics are NOT routinely required for uncomplicated Bartholin's abscess drainage 6
Management of Recurrent Cysts
- Consider marsupialization or excision rather than repeat Word catheter placement 5
- MRI may help guide treatment planning for complex recurrent cases 5
- Surgical referral is appropriate for severe or repeatedly recurrent infections 2
Critical Diagnostic Consideration
Malignancy must be excluded in women >40 years with a Bartholin's mass, as Bartholin gland carcinoma can present similarly to benign cysts 5