Bartholin gland cysts are generally 1 to 3 cm in size and asymptomatic. Drainage for a simple cyst is only needed for patient preference (ie outpatient). Bartholin gland abscesses develop 2-4 days and are generally larger than cysts (up to 8cm) and are symptomatic. Common symptoms and signs are dyspareunia, difficulty in walking, vulvar pain and vulvar erythema and edema. At one time it was thought that most bartholin gland abscesses were caused by gonorrhea and chlamydia although most are polymicrobial. If concerned for G/C infection cultures should be taken. Cysts and small abscesses can be initially managed with sitz baths. If home treatment fails or there is a large abscess then I/D with word catheter or alike should be undertaken. Antibiotic treatment is not indicated in immunocompetent patients after proper incision and drainage as long as there are no signs of cellulitis or systemic symptoms. If antibiotics are prescribed they should cover G/C. Immunocompromised patients may need inpatient admission due to their susceptibility to necrotizing infections and other complications such as sepsis. It is advocated that excision of bartholin gland cysts/abscess be deferred to GYN in patients over 40 years of age because of the possibility of cancer. Simple incision and drainage and especially needle aspiration have high recurrence rates. Failure of treatment with a Word catheter should be followed with marsupialization or sent to GYN for excision, marsupialization or a “window” procedure. Using silver nitrate in the cyst cavity has been described.
The procedure is easily learned from a text and straight forward. A word of caution… the filling needle for the Word catheter easily punctures the rubber side wall and it is recommended that the filling needle be placed into the injection port before starting the procedure as this will reduce accidental needle-stick injury. Also, bartholin gland abscesses are under intense pressure wear a gown, face mask and eye protection in addition to your gloves. TRUST ME……
Roberts and Hedges 5th ed., ch. 37
Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician. 1998 Apr 1;57(7):1611-6, 1619-20.
Wechter ME, Wu JM, Marzano D, Haefner H.Management of Bartholin duct cysts and abscesses: a systematic review. Obstet Gynecol Surv. 2009 Jun;64(6):395-404.