What is the treatment for a Bartholin cyst?

Treatment of Bartholin Cyst

For symptomatic Bartholin cysts or abscesses, incision and drainage with placement of a Word catheter or marsupialization is the recommended treatment, not simple lancing alone which leads to high recurrence rates. 1

Asymptomatic Cysts

• Expectant management is appropriate for asymptomatic Bartholin duct cysts, as many resolve spontaneously without intervention 2
• No treatment is required unless the cyst becomes symptomatic or infected 2

Symptomatic Cysts and Abscesses

When to Intervene

• Drainage is indicated when cysts or abscesses are larger than 2 cm, as these do not tend to resolve spontaneously and are prone to recurrence 2
• Infected cysts (abscesses) require drainage regardless of size if causing symptoms 2

Drainage Techniques (Avoid Simple Lancing)

Simple incision and drainage alone results in high recurrence rates and should be avoided 1. Instead, use one of these definitive techniques:

Word Catheter Placement (First-Line)

• Most frequently employed technique for office and emergency department management 3
• Allows for epithelialization of a drainage tract over 3-4 weeks 3
• Potential drawback: catheter may dislodge before complete epithelialization, leading to recurrence 3

Marsupialization

• Creates a permanent opening by suturing the cyst wall edges to the surrounding skin 1
• Can be performed in the office setting 1
• More definitive than Word catheter but slightly more invasive 4

Alternative Drainage Methods

• Loop of plastic tubing secured in place can serve as an alternative when Word catheter is unavailable 3
• Silver nitrate application and CO2 laser cauterization are additional options 4

Antibiotic Therapy

• Antibiotics should be prescribed when there are signs of cellulitis or systemic infection 5
• For abscesses, consider coverage for common pathogens including gonorrhea (penicillin and metronidazole have shown 95% cure rates in studies) 6
• Testing for sexually transmitted infections (gonorrhea, chlamydia) is warranted, as these are common pathogens in Bartholin gland infections 7

Surgical Excision

• Reserved for recurrent cysts that fail conservative drainage procedures 4
• Requires general anesthesia and is more invasive 4
• Consider referral to gynecologic surgeon for severe or recurrent infections 2

Important Caveats

• Rule out malignancy in women over 40 years old or with atypical presentations, as Bartholin gland carcinoma can mimic benign cysts 4
• Obtain culture material during drainage to guide antibiotic therapy 6
• Follow-up at 3 weeks to ensure resolution and remove drainage device 3