Treatment of Bartholin's Cyst
For symptomatic Bartholin cysts or abscesses larger than 2 cm, drainage with placement of a Word catheter or marsupialization should be performed, as simple incision and drainage alone leads to high recurrence rates. 1, 2
Asymptomatic Cysts
- Expectant management is appropriate for asymptomatic Bartholin duct cysts, as many resolve spontaneously without intervention 1
- No surgical intervention is required unless the cyst becomes symptomatic or infected 1
Symptomatic Cysts and Abscesses
Drainage Indications
- Infected Bartholin duct cysts or glandular abscesses larger than 2 cm should be drained, as they do not tend to resolve spontaneously and frequently recur without intervention 1
Drainage Techniques (in order of preference)
Word Catheter Placement:
- This is the most frequently employed technique for office and emergency department management 3, 2
- The catheter remains in place to allow epithelialization of a drainage tract, preventing recurrence 3
- Can be performed in the office setting under local anesthesia 2
Marsupialization:
- Equally effective as Word catheter placement and can be performed in the office 2
- Creates a permanent opening for drainage 2
Alternative Drainage Methods:
- A loop of plastic tubing can be used when Word catheters are unavailable, secured to prevent expulsion before epithelialization 3
- Alcohol sclerotherapy after aspiration destroys the epithelial lining through coagulative necrosis, with lower recurrence rates than aspiration alone 4
What NOT to Do
- Simple incision and drainage (lancing) should be avoided, as this results in high recurrence rates compared to other treatment methods 2
Antibiotic Therapy
- Antibiotics should be prescribed when there are signs of cellulitis or systemic infection 5
- Antibiotics are managed similarly to other cutaneous abscesses 5
- Oral antibiotics are typically prescribed after drainage procedures 3
Surgical Excision
- Reserved for recurrent cysts that fail conservative management 6
- More complicated procedure requiring general anesthesia 6
- Modern techniques include hydrodissection for excision 6