Bartholins Abscess

What is a Bartholin’s gland?

The Bartholin’s glands are sacs that produce fluid and are located on both sides of the vaginal opening. Normally they are not noticeable. Their job is to secrete a fluid, through a duct, into the vagina to keep it moist.

What is a Bartholin’s cyst or abscess?

Two in every 100 (2%) women develop a Bartholin’s cyst or abscess in their lives. A Bartholin’s cyst (fluid filled sac), which is normally not painful, forms when the duct leading from the gland to the vagina becomes blocked. It is unclear why this happens and there is little that you can do to prevent it. A Bartholin’s abscess (infected pus filled sac), which is normally very painful, develops when a Bartholin’s gland becomes infected.

What are the signs and symptoms of a Bartholin’s cyst and abscess?

A cyst or abscess can vary in size from the size of a small pea up to the size of a tennis ball. A Bartholin cyst can sometimes go unnoticed or have few symptoms.

Symptoms of a Bartholin’s abscess may include:

• A tender lump on one side of the vagina where the ducts are situated.
• Surrounding area that looks red, swollen and hot to touch.
• Discomfort and/or pain that is worse when pressure isapplied e.g. when sitting or walking.
• Pain during sexual intercourse.
• Pus oozing from the abscess (sometimes foul smelling).
• Discomfort when passing urine (stinging sensation).

What are the treatment options for the cyst or abscess?

Your doctor will discuss the most appropriate treatment options with you and explain the risks and benefits to you.

‘Watch and wait’ or expectant treatment

If you have a small cyst that is causing little or no symptoms then it may be best to leave it alone. The same is true if you have an abscess that has already started to discharge.

Usually these will resolve with time. Take pain relief and soak the area in warm water up to three times a day for 20 minutes at a time to help relieve symptoms and to encourage the cyst to burst or the abscess to discharge further.

However, if the cyst becomes painful or the abscess stops discharging and grows bigger you may need further treatment.

Antibiotic treatment

If you have a small abscess (smaller than 3 cm) and the doctor feels that you would not benefit from surgery, you may be offered a course of antibiotics. This has a good chance of curing small abscesses.

If you have had expectant or medical management of your Bartholin’s cyst/ abscess you may be asked to come back to the acute gynaecology unit within a week to see if your symptoms are improving. Your doctor will discuss this with you.

Surgical treatment

There are two surgical options that you may be offered. These are Word Catheter insertion or Marsupialisation.

1. Word Catheter insertion under local anaesthetic

This is the preferred surgical way to treat Bartholin’s cyst or abscess. This is a procedure that is performed under local anaesthetic. It takes 5-10 minutes to perform.

A local anaesthetic is given. Then an incision (cut) is made into the cyst or abscess to allow the fluid or pus to drain out. A swab is taken to test for the bacteria which caused the infection. Occasionally, a small sample of tissue is taken from the cyst wall. Then a Word catheter which is a small balloon catheter is put into the opening. It is left in place for up to 4 weeks to allow fluid to come out. This method reduces the risk of a recurrence. The catheter may fall out before the four weeks are over. This is not usually a problem and you should still heal successfully. However, if it falls out within 5 days of having it put in we would recommend that you get seen by a doctor and you may need another one inserted.

If you have been diagnosed with a Bartholin’s abscess or cyst, you can normally have this procedure performed during the same visit. You may be advised to take pain relief before and after the procedure. You should be able to go home soon after the procedure (within 1 hour).

You should be able to return back to normal daily activities (including exercise and sex) within 3 days. You will be offered an appointment to be seen back in the acute gynaecology clinic for removal of the catheter and a review of your symptoms in four weeks’ time.

2. Marsupialisation

This is a procedure that is performed either under local (where you are awake but the area is numbed) or general (when you are asleep) anaesthetic. It takes 10 to 15 minutes to perform. An incision (cut) is made into the cyst or abscess to allow the fluid or pus to drain out. This leaves a small opening or pouch that is kept open with dissolvable stitches.

The operating doctor may insert a small piece of gauze into the pouch to aid the remaining pus/fluid to drain and to reduce the risk of another cyst reforming. Please make sure you take pain killers (such as paracetamol or ibuprofen) when you get home if you feel discomfort.

Please be aware that if, due to other very unwell patients requiring surgery, your operation cannot be done before midnight on the day of your admission we will cancel your operation until the next day. For patient safety reasons we do not operate during the night unless your condition is life threatening. In most cases you should be able to go home within six hours of having your operation. The nurse will check that you are able to walk around and pass urine and will also check your wound before you go home.

What to do when you go home: 

• Rest for two or three days after leaving the hospital.
• Take daily baths or showers. Avoid scrubbing or rubbing area vigorously for at least two weeks. Avoid bubble bath, oils and talcum in that area while wound is healing.
• Avoid sex until there is no discharge and you are pain free.
• Take painkillers if you need them.
• Avoid tight fitting clothes e.g. slim fit jeans or underwear until you are pain free.If there is evidence of infection in the skin surrounding the Bartholin’s abscess (cellulitis) you may be prescribed a course of antibiotics.

Comparison of word catheter and marsupialisation

What to expect after surgical management of Bartholin’s cyst/ abscess

It is common to feel the following symptoms:

• Wound pain which can be controlled with pain killers as required.
• Wound oozing or slight bleeding which usually settles over the course of a week or two.
• If you have had a general anaesthetic you may experience nausea.