Bartholin Cyst Treatment Guidelines
For Bartholin duct cysts and abscesses, drainage is the primary treatment when the lesion is larger than 2 cm, as these do not resolve spontaneously and tend to recur without intervention. 1
Asymptomatic Cysts
- Small, asymptomatic Bartholin duct cysts (<2 cm) can be managed expectantly, as many resolve spontaneously without intervention 1
- No surgical drainage is required for non-infected cysts that remain asymptomatic 1
Infected Cysts and Abscesses (>2 cm)
Antibiotic Therapy
- Antibiotics should be prescribed when there are signs of cellulitis or systemic infection, similar to management of other cutaneous abscesses 2
- Antibiotics alone are generally insufficient for definitive management of established abscesses 1
Drainage Procedures (Primary Treatment)
The following surgical options are available, listed by recurrence rates:
Marsupialization (Lowest Recurrence)
- Marsupialization shows 0% recurrence in available studies, making it the most definitive option 3
- This involves creating a permanent opening by suturing the cyst wall edges to the surrounding skin 3
- Healing typically occurs within 2 weeks or less 3
Word Catheter Placement
- A commonly employed technique for office and emergency department management 4
- Recurrence rates vary from 2-25% across different surgical techniques 5
- The catheter has a tendency to dislodge before epithelialization, leading to potential recurrence 4
- Alternative drainage devices include Foley catheters or Jacobi rings 3
Alternative Drainage Methods
- Simple needle aspiration alone has the highest recurrence rate among drainage techniques 3
- Aspiration with alcohol sclerotherapy shows improved outcomes compared to aspiration alone 3
- CO₂ laser fenestration, ablation, or excision is another option 3
- Silver nitrate gland ablation can be considered 3
Gland Excision (Reserved for Recurrent Cases)
- Complete excision is typically reserved for recurrent cysts or when malignancy is suspected 6, 3
- This is a more complicated, bloody procedure often requiring general anesthesia 6
- In postmenopausal women, consider malignancy and biopsy tissue 5
Clinical Pitfalls
- Do not rely on antibiotics alone for abscesses >2 cm - drainage is essential 1
- Ensure adequate epithelialization time (typically 4-6 weeks) before removing drainage devices to prevent recurrence 4
- Evaluate for malignancy in postmenopausal women presenting with Bartholin gland masses 5
- Simple incision and drainage without a drainage device or marsupialization leads to higher recurrence rates 3