OverviewThe Bartholin’s glands are located at the entrance to the vagina and secrete mucous to provide moisture to the vulva. Normally, the glands are the size of a pea and cannot be felt unless they become inflamed. Occasionally, the opening of the gland becomes blocked due to inflammation or trauma. Fluid can build, creating a swollen cyst or abscess. Two percent of women may develop a Bartholin’s abscess during their lifetimes. The abscess may become very large (up to 8 cm) and cause a woman significant pain with sitting, walking or during intercourse. The abscess will often burst in four to five days, but still may not resolve on its own.
Bartholin’s cysts can be present without causing pain or other symptoms. These do not need to be treated and often self-resolve over time. When the fluid inside the cyst becomes infected, called a Bartholin’s abscess, the area becomes red and painful and requires treatment.
Multiple treatment approaches are used to counter Bartholin’s abscess: sitz baths and a course of antibiotics, marsupialization, Word catheter placement, or removing the entire Bartholin’s gland. The goal of treatment is to remove the infected fluid and allow the area to continue to drain properly. Cancer of the Bartholin’s gland is extremely rare (0.114 per 100,000 woman-years), but should be considered if a Bartholin’s abscess develops after menopause, particularly if the gland is irregular in appearance.
Plan to take the day off work if you are having either a Bartholin’s abscess treated either by marsupialization or Word catheter placement.
- Sitz baths and a course of antibiotics: If the abscess has ruptured on its own, frequent sitz baths and antibiotics may be all that is necessary for treatment. A “sitz” bath simply refers to sitting in warm water and can be done in a bathtub or using a specialized plastic bucket between 20 and 30 minutes at least three times a day. Unfortunately, a Bartholin’s abscess often recurs when not treated with marsupialization or Word catheter placement, particularly if the rupture site is small and reseals before a new gland opening has completely formed.
- Marsupialization: This procedure can be performed in a clinic, emergency room or operating room using local anesthesia in 10-15 minutes. After the area is numbed, an incision is made through the cyst wall. The cyst wall is then stitched to the vagina to keep the edges open and allow the cyst to continue draining. The opening to the Bartholin’s gland will decrease in size over time until it forms a new duct opening. The chance that the Bartholin’s abscess comes back after marsupialization is about 10 percent.
- Word catheter placement: A Word catheter can also be used to treat a Bartholin’s abscess in a clinic, emergency room or operating room in 10-15 minutes. The Word catheter is a small rubber catheter about 1 inch long that has a small balloon at the end. Local anesthesia is given to numb the area. A small incision is made in the wall of the Bartholin’s cyst and the fluid is allowed to drain. The end of the catheter is placed inside the cyst and the balloon is filled with a small amount of water. Filling the balloon with water simply keeps the catheter in place so that the cyst can continue to drain. Over time, the Bartholin’s gland will form a new duct opening at the site of this incision. Ideally, the Word catheter stays in place for up to four weeks, but it is common for the catheter to fall out earlier during the healing process. If the catheter falls out earlier than four weeks, tell your doctor. This is unlikely to affect the healing process if the catheter has been in place for more than one week.
- Removal of the Bartholin’s gland: Patients with several recurrences of a Bartholin’s abscess may choose to have surgical removal of the entire Bartholin’s gland, which is as an outpatient surgery taking about 30 minutes. This procedure requires either general or regional anesthesia. There is a rich blood supply to the Bartholin’s gland and removal of the gland can result in significant bleeding during surgery or a postoperative blood clot in the area. Following removal of a Bartholin’s gland it is extremely important to avoid heavy lifting or exertion that may strain stitches at the site for at least two weeks.
EffectivenessMarsupialization and Word catheter placement are typically 90 to 95 percent effective, but some patients continue to have recurrent Bartholin’s abscesses after these treatments. Surgical removal of the entire Bartholin’s gland may then need to be performed in an operating room. This is an outpatient surgery and women go home the same day. The Bartholin gland is not necessary for vaginal lubrication of sexual function.
RisksMarsupialization and Word catheter placement are both very safe procedures. The main risk is that the Bartholin’s abscess will recur, which happens in 10 percent of cases. There is also minor discomfort before and during the procedure. Surgical removal of the Bartholin’s gland may lead to bleeding during surgery or postoperative bleeding in the wound in about 5 percent of cases.
UrgencyMarsupialization and Word catheter placement are 90 percent effective with a Bartholin’s abscess recurring in 10 percent of cases.