From the Guidelines
Treatment for a Bartholin's cyst should prioritize conservative approaches, such as warm sitz baths and oral antibiotics, before considering more invasive options like drainage procedures or gland excision. When considering treatment options, it's essential to evaluate the severity of symptoms and the presence of infection. For mild, asymptomatic cysts, no treatment may be necessary as they often resolve on their own 1. If the cyst is painful or infected, warm sitz baths for 10-15 minutes three to four times daily can help reduce discomfort and promote drainage. Some key points to consider when treating Bartholin's cysts include:
- The location of the Bartholin glands, which are located in the posterior vestibule at the 4 and 8 o’clock positions 1
- The potential for infection by STI pathogens, including gonorrhea and chlamydia 1
- The importance of assessing for other genital tract anomalies, such as a vertical or transverse vaginal septum 1 For infected cysts (Bartholin's abscess), oral antibiotics such as amoxicillin-clavulanate or doxycycline may be prescribed. If conservative measures fail or the cyst is large and symptomatic, drainage procedures are recommended, such as word catheter placement or marsupialization. Gland excision may be considered as a last resort for recurrent cysts. It's crucial to note that these treatments are effective because they address the underlying issue of blocked Bartholin's gland ducts, which can cause pain, swelling, and discomfort during walking or sexual activity if left untreated.
From the Research
Treatment Options for Bartholin's Cyst
- Expectant management with comfort measures for asymptomatic Bartholin duct cysts that are not infected, as they may resolve spontaneously 2
- Medical management, including broad-spectrum antibiotic therapy, for infected Bartholin duct cysts or gland abscesses 3
- Surgical management, including:
- Marsupialization, a procedure that involves creating a new opening for the cyst to drain 3, 4, 5
- Insertion of a Word catheter, a small tube that is inserted into the cyst to allow it to drain 3, 4, 5
- Incision and drainage, a procedure that involves making a small cut in the cyst to allow it to drain 4, 5
- Silver nitrate gland ablation, a procedure that involves using a chemical to destroy the gland 4, 5
- Fistulization, a procedure that involves creating a new connection between the cyst and the outside of the body 4
- Excisional biopsy, a procedure that involves removing the gland and sending it to a laboratory for testing 3
Recurrence and Healing Rates
- The reported frequency of recurrence varies from 0% to 38% depending on the treatment used 4
- Marsupialization has been shown to have a low recurrence rate, with no recurrences reported in some studies 4
- Healing generally occurs in 2 weeks or less, regardless of the treatment used 4
Choosing a Treatment Approach
- The choice of treatment approach depends on the size and severity of the cyst or abscess, as well as the patient's overall health and preferences 2, 3, 6
- A systematic review of the literature found that there is no consensus on the best treatment approach for Bartholin's cyst or abscess, and that further research is needed to identify an effective treatment 5