[CG] Bartholin’s cyst and abscess, management of

Warning

exp date isn't null, but text field is

Please report any inaccuracies or issues with this guideline using our online form

Background

The Bartholin’s gland is a mucus secreting gland located bilaterally at the base of the labia minora, at the level of the hymen. When the duct becomes blocked, a cyst may form and the gland may be palpable. If the cyst becomes infected, an abscess may form which can cause severe pain. The life-time risk is approximately 3%. 

Clinical Features

Patients will present with a painful unilateral swelling in the vagina. 

On examination, there will be a tender, erythematous swelling at 4 or 8 o’clock on the lateral vaginal wall. Tracking of the abscess along the vaginal wall may cause cellulitis. 

Differential diagnosis

  • Inclusion cyst
  • Gartner duct cyst
  • Haematoma
  • Sebaceous cyst
  • Lipoma
  • Hidradenitis suppurativa
  • Endometriosis

Investigations

A charcoal swab should be obtained from the abscess and sent for culture and sensitivity. Bartholin’s duct abscesses may be polymicrobial: streptococcus, staphylococcus, anaerobes and Neisseria gonorrohoea may be identified. High vaginal and endocervical swabs may also be taken for chlamydia and gonorrohoea if there is risk of a sexually transmitted infection. 

Management

This will depend on the severity and the duration of the patient’s symptoms.
 

Conservative

Hot baths several times per day and simple analgesia.

Medical

Add in antibiotic treatment (co-amoxiclav 375mg TID or clindamycin 300mg QDS if penicillin allergic).

Surgical Management - Word Balloon Catheter

This treatment should be used first line for Bartholin’s abscesses. This is a very well tolerated procedure and has good operative success. 

The word catheter kits contain the 3cm long catheter itself, a syringe for inflation and the scalpel. A local anaesthetic, such as 1% lidocaine, may be used to infiltrate the skin prior to the initial incision being made. Via a 5mm stab incision into the mucosal surface of the labia minora, the catheter is inserted and inflated with ≤3ml of saline, as per the manufacturer’s guidelines. If the balloon is overfilled this may cause extra discomfort so the balloon should be deflated by extracting some saline. If the incision is made too large the catheter may fall out so an anchor suture may be required to hold it in place. The patient can go home with the catheter in situ and usually this stays in for 4 weeks to encourage formation of an epithelialised fistula and prevent refilling of the abscess. A patient information leaflet should be given with a contact number for the gynaecology emergency service. After this time the catheter is deflated and removed. If the catheter falls out at home during this time it may be left out provided the patient’s symptoms are resolving. 

Incision and Drainage 

This can be done under local or general anaesthetic depending on the size of the abscess and severity of the symptoms. A charcoal swab should be obtained from the pus within and sent to bacteriology. Intravenous antibiotics (1.2g of co-amoxiclav or 900mg clindamycin) should be given during the procedure to minimise risk of infection. Packing is not routinely required. 

Marsupialisation 

Where there is a recurrent abscess, marsupialisation under a general anaesthetic should be performed. The purpose of this is to create a fistula and prevent further abscess formation. Again, intravenous antibiotic (1.2g of co-amoxiclav or 900mg clindamycin) cover should be given in theatre. Packing is not routinely required. 

Biopsy

A biopsy may be indicated in women over 40 years old as there is an increased risk of adenocarcinoma of the Bartholin’s gland. 

Follow up

This is not routinely required after incision and drainage or marsupialisation of the abscess. If patients have already been commenced on oral antibiotics, they may wish to complete the course. However, they do not routinely need to start treatment, provided antibiotic cover has been given at the time of the procedure. Simple vulval hygiene advice should include avoiding bubble baths, lotions or talcum powder. Sexual intercourse should be avoided until there is no pain or discharge. 

Related resources
References

Inserting an inflatable balloon to treat a bartholin’s cyst or abscess’ Interventional Procedure guidance 323. December 2009. National Institute for Health and Clinical Excellence (NICE)

Management of bartholin duct cyst and abscesses. A systematic review’ Wechter Wu, Marzano and Haefner. Volume 64, Number 6 Obstetrical and Gynaecolocal Survey 2009. 

Last reviewed: 01 May 2017

Next review: 30 September 2022

Author(s): Dr Joy Simpson

Version: 2

Document Id: 066