Bartholin’s Cyst or Abscess

artholin’s glands are small sacs, located one on each side, just inside the entrance to the vagina. These glands produce fluid which enters the vagina through a small duct (tube) from each gland.  

A Bartholin’s cyst develops when the duct becomes blocked and the fluid becomes trapped in the sac. A Bartholin’s cyst often causes no symptoms but can become uncomfortable if it gets very big. 

The cyst may turn into an abscess (a sac containing pus) if it becomes infected, and this can result in severe discomfort and pain. 

A Bartholin’s cyst may be as small as a pea or bigger than a golf ball. You may feel a lump on one side of the vagina, which feels like it contains fluid. The size may increase or decrease over time.  

Signs of an infected cyst, or abscess, are: 

• Red and swollen skin which is tender to touch. 
• Pain on pressure, for example when sitting or walking.  
• Smelly discharge from the cyst. 
• Feeling unwell in yourself, or having a fever. 
• Painful lymph glands in the groin.

There are three options: 

1. Conservative or “watch and wait”.  
2. Outpatient surgical treatment.  
3. Inpatient surgical treatment. 

1. Conservative management  

Bartholin’s cysts that are not infected and do not cause symptoms do not normally need to be treated.  

Bartholin’s abscesses may respond to antibiotics and soaking in warm water to encourage the abscess to drain. You can take over-the-counter pain relief. 

Sometimes the cyst or abscess drains (bursts) spontaneously and you will notice a discharge followed by your symptoms improving quickly on their own. 

2. Outpatient surgical treatment – ‘Word catheter’ insertion under local anaesthetic  

Word catheters are small silicone tubes, around 3cm long, with an inflatable balloon at the end. These are inserted under local anaesthetic (a numbing injection given at the start of the procedure). Once we have checked the skin is numb, a small cut is made in the cyst and the fluid is drained. The tip of the catheter is then inserted into the cyst and the balloon is inflated to keep the catheter in place. The aim of the catheter is to stop the opening from closing up, so that a new duct can form over the catheter, helping to prevent blockage of the gland in the future.  

The procedure is usually performed in the gynaecology outpatient department and takes approximately five minutes. It can be uncomfortable, especially if the area is already very sore from any infection, but the numbing injection is very effective, and you will be supported by the team and can stop the procedure at any point if any pain is unmanageable. At the end of the procedure, the free end of the catheter can be tucked into the vagina or left free. The catheter should stay in for three to four weeks. You can gently exercise and have sex if you wish during this time. You will be asked to return to clinic for removal of the catheter. 

As it is quick and simple, with high success rates, this is the option we generally recommend for treatment. However, some women will find the procedure painful to have done while awake, especially if there is a severe infection or a very large abscess. Sometimes the catheter will be uncomfortable while it is in: often this can be relieved by removing a small amount of fluid from the balloon in clinic. Occasionally the catheter will fall out – if this happens within the first few days, it may be possible to reinsert a new catheter. If it falls out later then you should leave the abscess or cyst to heal without having a new one put in. 

3. Inpatient surgical treatment – Marsupialisation

This is a procedure that is usually performed under general anaesthetic (while you are asleep), but can also be performed while you are awake (using local anaesthetic, as above). A cut is made into the cyst/abscess to drain it, and then the edges of the cyst/abscess are stitched to keep the cyst open, to try and prevent the cyst from re-forming.  

Sometimes the open cyst has a gauze ‘ribbon’ placed inside it to prevent bleeding, which is removed a few hours later. You will usually go home the same day. The stitches dissolve naturally within a few weeks.  

This procedure requires a longer hospital admission and general anaesthetic. There are small risks associated with having a general anaesthetic, and, as with Word catheter insertion, you will have some discomfort or mild pain as the area heals.  

You may find the following comparison of marsupialisation and insertion of a Word catheter helpful: 

Surgical excision or removal of the Bartholin’s gland itself is only recommended as a last resort, if a cyst or abscess repeatedly reforms on the same side. This is because it is a complex operation, which is not always successful, and can cause scarring and pain. It is best done when the cyst is not infected or swollen.

We want to involve you in all the decisions about your care and treatment.  Staff will explain all the risks, benefits and alternatives of the treatment options. If you would like a procedure performed under general anaesthetic, you will be asked to sign a consent form as a record of the conversation, and of your wishes.  

If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff again. 

If you would like more information or have any concerns after treatment, please contact Clinic 3 specialist nurse on the details below. 

You may also find the following NHS website helpful: 

Bartholin's Cyst

PALS 

The Patient Advice and Liaison Service (PALS) is a service that offers general support, information and assistance to patients, relatives and visitors. The PALS office is located on Ground Floor Atrium.

020 3447 9975 

PALS@uclh.nhs.uk 

Address: PALS, Ground Floor Atrium, University College 

Hospital, 235 Euston Road, London NW1 2BU

Gynaecology Diagnostic and Treatment Unit

Direct line: 020 344 76515 (please leave a voicemail) 

Email: uclh.epunurses@nhs.net  

Opening Times: 

Monday-Friday: 09:00 – 17:00 

For gynaecological issues, you must be referred to us by your GP, the Emergency Department or another medical team.

The Gynaecology Diagnostic and Treatment Unit is located on the lower ground floor of the Elizabeth Garrett Anderson Wing. Follow signs to Clinic 3.

Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren P, Radder CM, van der Voet LF, Roovers J, Graziosi G, van Baal WM, van Bavel J, Catshoek R, Klinkert ER, Huirne J, Clark TJ, Mol B, Reesink-Peters N. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG. 2017 Jan;124(2):243-249. doi: 10.1111/1471-0528.14281. Epub 2016 Sep 19. PMID: 27640367.