Incision and Drainage for Bartholin Cyst During Menstruation
Yes, incision and drainage of a Bartholin cyst or abscess can be safely performed during a menstrual period—menstruation is not a contraindication to this procedure.
Rationale for Proceeding During Menses
The available evidence does not identify menstruation as a contraindication or complicating factor for Bartholin cyst/abscess management. The key considerations for timing this procedure relate to:
- Infection severity and size: Infected Bartholin duct cysts or gland abscesses larger than 2 cm should be drained promptly because they do not resolve spontaneously and can recur 1
- Symptom burden: These lesions can significantly affect day-to-day functioning and cause substantial pain, making timely intervention important 1
- Preservation of gland function: The goal is to preserve the gland and its function, which is best achieved through appropriate drainage techniques rather than delayed treatment 2
Practical Considerations
While menstruation does not preclude the procedure, consider these practical points:
- Visualization: Menstrual blood may slightly complicate visualization of the surgical field, but this is manageable with proper technique and does not represent a true contraindication
- Patient comfort: Some patients may prefer to delay elective procedures during menses for personal comfort, but this should be weighed against symptom severity
- Infection risk: There is no evidence that menstruation increases infection risk for this procedure, as the Bartholin glands are located at the posterior introitus (4 o'clock and 8 o'clock positions) and drain into the vestibule 2
Recommended Approach
For symptomatic or infected cysts >2 cm, proceed with drainage regardless of menstrual status 1. The procedure options include:
- Word catheter placement: Effective office-based procedure for both duct cysts and gland abscesses 2, 3
- Marsupialization: Appropriate for cysts but should not be used for active gland abscesses 2
- Simple incision and drainage: While quick and easy, this has higher recurrence rates and is generally not recommended as the primary approach 4
Common Pitfalls to Avoid
- Delaying treatment unnecessarily: Waiting for menstruation to end when a patient has a symptomatic abscess >2 cm delays relief and risks progression 1
- Simple lancing without catheter placement: This results in higher recurrence rates compared to Word catheter or marsupialization 3
- Routine antibiotic use: Broad-spectrum antibiotics are warranted only when cellulitis is present, not for routine drainage procedures 2