From the Guidelines
Treatment of Bartholin's cysts should prioritize symptom severity and cyst size, with conservative management using warm sitz baths for asymptomatic small cysts, and surgical drainage with word catheter placement for symptomatic or larger cysts. When considering treatment options, it's essential to evaluate the severity of symptoms and the size of the cyst. For asymptomatic small cysts, conservative management with warm sitz baths 2-3 times daily for 10-15 minutes is recommended, which may help the cyst drain spontaneously 1. For symptomatic or larger cysts, surgical drainage is typically necessary, with word catheter placement being the preferred treatment, involving a small incision to drain the cyst followed by insertion of a catheter that remains in place for 4-6 weeks to create a new duct opening. Some key points to consider when treating Bartholin's cysts include:
- Conservative management for asymptomatic small cysts
- Surgical drainage with word catheter placement for symptomatic or larger cysts
- Marsupialization as an alternative surgical option for recurrent cysts
- Treatment of infected cysts (Bartholin's abscess) with incision and drainage along with antibiotics
- Definitive treatment for recurrent or problematic cysts in women over 40 may involve gland excision, though this carries higher risks of bleeding, scarring, and dyspareunia. It's also important to note that the provided evidence 1 discusses the clinical features of skin and soft-tissue infections, but does not directly address the treatment of Bartholin's cysts. However, the general principles of managing skin and soft-tissue infections can be applied to the treatment of Bartholin's cysts, particularly in cases of infection.
From the Research
Treatment Options for Bartholin's Cyst
- Definitive methods for treatment of a Bartholin cyst and abscess include placement of a Word catheter, marsupialization, application of silver nitrate, and surgical excision 2
- Placement of a Word catheter is the most frequently employed technique for office and emergency department (ED) management 2
- Marsupialization is also a common treatment option, with studies comparing its effectiveness to Word catheter treatment 3, 4, 5
Effectiveness of Word Catheter and Marsupialization
- A study found that Word catheter treatment was successful in 87% of cases, with a recurrence rate of 3.8% 3
- Another study found that marsupialization had a lower recurrence rate (8.3%) compared to Word catheter (18.8%) 4
- A randomized clinical trial found that Word catheter and marsupialization had comparable recurrence rates (12% and 10%, respectively) 5
Management Approach
- Management options for Bartholin duct cysts and gland abscesses fall under three broad categories: expectant, medical, or surgical 6
- Infected Bartholin duct cysts or glandular abscesses should be drained when larger than 2 cm, as they do not tend to resolve spontaneously and can recur 6
- Midwives and women's health nurse practitioners can manage many women who present with Bartholin duct cysts or gland abscesses, with referral to a surgeon rarely needed for severe or recurrent infections 6