Bartholin’s Cyst/Abscess | North Bristol NHS Trust

Bartholin’s glands

Bartholin’s glands are two pea size glands that are located next to the vaginal entrance (one on the right and one on the left) and they cannot normally be seen or felt. They normally secrete a small amount of fluid through a duct which keeps the entrance of the vagina moist. If the duct becomes blocked this can form a fluid-filled swelling (a cyst). If the cyst becomes infected the swelling may become filled with pus (then called an abscess). Bartholin’s cyst or abscess affect up to 3 in 100 women and can be treated with antibiotics or with a small procedure/operation to drain the collection.

Symptoms of a Bartholin’s cyst/abscess

A Bartholin’s cyst or abscess usually only affects the gland on one side. Bartholin’s cysts which remain small and do not become infected may not give any symptoms and do not usually need any treatment. Sometimes if the cyst becomes large it may cause discomfort or pain, especially when walking, sitting, or during sex. If an abscess forms it can enlarge quickly, over hours or days, and is usually very painful. The skin over the abscess often becomes red and hot and there may be discharge from it. It may also be associated with feeling unwell and a high temperature.

Diagnosis

Bartholin’s cysts and abscesses have characteristic appearances and can be diagnosed by a vaginal examination by a doctor. No tests are usually required to make the diagnosis.

Treatments

A small cyst that does not cause symptoms may resolve by itself and often does not require any treatment. However a ‘lump’ in the area around the vagina should always be reported to your doctor and examined by them.

A Bartholin’s abscess usually requires treatment as it can be very painful. Antibiotics may help in the early stages but a small procedure is often needed to drain the pus. The main aim of treatment is to remove the pus (to treat the abscess) and to create a new opening or duct to prevent blockage (and therefore a cyst or abscess forming) in the future.

There are different ways of treating the abscess:

Bartholin Gland Balloon (Word Catheter): performed under local anaesthetic
Marsupialisation: performed under general anaesthetic
Incision and Drainage: not usually recommended for Bartholin’s cyst or abscess

The Bartholin Gland Balloon (Word Catheter)

This technique has been designed to treat Bartholin abscesses. The word catheter is a thin rubber tube 3cm long with an inflatable balloon at one end which is inserted under local anaesthetic. A small local anaesthetic injection is often given to numb the skin and make the procedure more comfortable.

A small cut is made in the cyst or abscess and the fluid or pus is drained. The head of the catheter is then inserted into the cyst or abscess and the balloon is inflated to keep the catheter in place for 2-4 weeks.

The aim of the Word catheter is to stop the opening from closing up, so that a new duct can form over the catheter.

Keeping the new duct open helps to allow normal secretions from the Bartholin’s gland to escape which can help to prevent further blockage in the future.

Marsupialisation

In some circumstances it may not be possible to perform a procedure under local anaesthetic and in these cases ‘marsupialisation’ is recommended, which is performed under a general anaesthetic.

The procedure of ‘marsupialisation’ involves making a small cut in the cyst or abscess, draining the fluid or pus and then placing some dissolvable stitches around the edges to allow the new opening to heal. This allows any fluid or pus that is left to drain freely. It also allows the normal secretions of the Bartholin’s gland to drain and helps to prevent a cyst or abscess forming again in the future.

Sometimes a small gauze dressing is used, which is left in the duct following this operation to help healing. You will be told if this has been used and when it needs to be removed following the procedure.

Incision and drainage

Incision and drainage can be used to treat other types of cyst or abscess and involves simply making a small cut in the cyst or abscess and letting it drain. It can be performed under local or general anaesthetic.

However it is not usually recommended for cysts or abscesses affecting the Bartholin gland because it does not help the duct to stay open. This means there is a higher chance of the Bartholin’s duct becoming blocked again leading to another cyst or abscess in the future.

Complications

As with any procedure there may be complications. The risk of complications during treatment of a Bartholin’s cyst or abscess is very small. The risks to be aware of for the Bartholin Gland Balloon (Word Catheter) and Marsupialisation include:

Discomfort at the site where the small cut is made (and where stitches are placed in the case of Marsupialisation)
Infection – increasing redness, inflammation or pain around the area or feeling feverish and unwell. You will be given antibiotics to help treat the abscess which greatly reduces the risk of further infection
Bleeding – from the small cut made in the skin
Bruising – around the abscess
Recurrence of the cyst or abscess

If you are concerned about any of these or feel unwell following your procedure, you can contact the ward using the contact details below or see your GP.

Recovery

You may be sent home with a course of antibiotics and painkillers to take. It is important to keep the area clean and dry to help it heal. We advise using warm water to wash and avoid soaps or gels.

Bartholin Gland Balloon (Word Catheter)

While the catheter is in place it is ok to go about normal daily activities and most women are not aware of it. You may find warm baths are helpful if there is any discomfort. You are advised to avoid tampons and intercourse whilst the catheter is in place.

If the catheter should fall out do not worry – please contact the ward and you will be seen at the next appointment. Most women still find that the treatment has worked even if the catheter has fallen out.

You will be given an appointment to return to the clinic in 2 weeks – most women will have the catheter removed at this time as it will have done its job and the duct is now open. Some women may need the catheter in for a further 1 or 2 weeks.

Marsupialisation

Once you wake up from the general anaesthetic you will be in ‘Recovery’, which is made up of a few beds close to the operating theatres. You will stay here to rest until you are fully awake and feeling well enough to return to Cotswold ward.

On Cotswold ward the nurses will check your vital signs (blood pressure, pulse and breathing). Once you have had something to eat and drink, have passed urine and feel well enough, you will be able to go home later the same day. Very rarely we may recommend you stay in overnight, and will explain why we are recommending this for you.

Before you go home you will be seen by a doctor who will explain the procedure, check that you are well enough to go home and answer any questions.

The medicines in a general anaesthetic can stay in your system for several hours and can affect your reaction times and judgement.

Here is some advice for after you have had a general anaesthetic:

You MUST NOT drive or operate machinery (including cooker/oven) for the following 24 hours
You should have somebody with you for the following 24 hours
You should avoid alcohol in the following 24 hours
You should rest and take things easy until you are feeling fully recovered
You should not make important decision or sign legal documents

Recurrence

Unfortunately the Bartholin’s gland duct can become blocked again in the future which can lead to a further Bartholin’s cyst or abscess. This might mean that treatment needs to be repeated.

The Bartholin balloon catheter has been approved as a treatment for Bartholins abscesses and the risk of another abscess developing low with this treatment.

Prevention

Bartholin’s cysts or abscesses usually appear ‘out of the blue’ for no apparent reason so there is usually no way to prevent them. However some Bartholin’s abscesses are caused by sexually transmitted infections so using a condom during sex can help to prevent some cases.

Further information

NHS Choices: www.nhs.uk/conditions/Bartholins-cyst

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

Cotswold ward, Brunel building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
Cotswold ward (24 hours)

0117 414 6785