Treatment Options

In this section, you’ll read about treatment options and symptom management if you have a Bartholin gland cyst or abscess.

In all cases, please always remember to contact your healthcare provider if you’re not sure about something.

Please seek urgent medical care if you have:

  • New fever (oral temperature > 38° Celsius)

  • Worsening pain/swelling/redness

  • Increasing discharge (green/yellow fluid with foul odour)

  • Red streaks leading away from the area

What to do if it’s your first episode

Mild Symptoms

Sitz Bath

If it is your first episode of a Bartholin’s gland cyst or abscess and there is only mild pain/pressure, small swelling (less than 1-2cm) and there is no redness and no fever, you should begin with a sitz bath.

A sitz bath involves sitting in a bathtub or in a shallow basin over your toilet bowl with a few inches/10 centimetres of warm water for 15-20 minutes 3 times a day if possible. Gently dry the area and avoid rubbing. The warm water helps the area heal. Avoid bubble baths as they may irritate the skin.

To learn more about taking a sitz bath either in your bathtub or using a device over the toilet, visit: https://www.wikihow.com/Take-a-Sitz-Bath

Over the counter pain relief

You can also take over-the-counter pain medication such as acetaminophen or ibuprofen. If symptoms are not improving within a few days, consider seeing a healthcare provider.

Moderate to Severe Symptoms

When to contact a healthcare provider

If it is your first episode and there is:

  • more severe pain

  • or a very large lump

  • or there is redness

  • or a fever

If any of the above symptoms are present you should contact your healthcare provider. You will likely need some sort of drainage to release infected fluid from the abscess. You may also be prescribed antibiotics, however, abscesses are unlikely to go away with antibiotics alone as the infected material - or pus - needs to exit the body.

Symptom management

You can still begin with a sitz bath and over-the-counter pain medication to ease your symptoms until you reach your healthcare provider.

Recurrent Episodes

Unfortunately, Bartholin Gland Abscesses often come back. Research indicates up to 10-20% recurrence at one year, regardless of initial treatment. If you have a second (or more episodes) you can still begin with sitz baths and pain medicine. However, if your symptoms are moderate to severe (more severe pain or a very large lump or there is redness or a fever) you will likely require drainage.  

You may also be eligible for a procedure called “marsupialization”. This treatment is usually performed by a Gynecologist. If you have had many recurrences, some Gynecologists may offer procedures such as removal of the gland or alcohol sclerotherapy.

Drainage Options

Your treatment options will vary depending on where you live and the practitioners available.

You may see a Nurse Practitioner, Family Physician, Gynecologist or Emergency/A&E Provider for drainage of your abscess.

Needle aspiration

Your healthcare provider (HCP) will disinfect the area and inject a local anesthetic (“freezing”) to numb the area. They will then pull out the infected fluid using a small needle. The leftover hole is tiny and will not allow further pus to drain out.

Incision and Drainage “I&D”

Your HCP will disinfect the area and inject a local anesthetic (“freezing”) to numb the area. Once it is numb they will cut a small hole on the inside of the labia minora to release the infected fluid. They may apply some pressure to help drain the fluid. Some HCPs may insert a small ribbon of gauze to help the hole stay open a bit longer to get more fluid out.

Incision and drainage (and fistulization) with Word Catheter insertion

This is the preferred drainage option in many settings. The first part of this procedure is the same as a regular I&D. After making the incision, a small rubbery tube will be placed inside the abscess. 2-3ml of saline or sterile water will be injected into the tube, inflating a tiny balloon that will sit inside the abscess pocket. The other end of the small tube will be tucked just inside the vagina opening. The Word catheter creates an alternative track (aka fistula) for the infected fluid in the abscess to drain out over the next few weeks. The catheter is small enough that you should not feel it once inserted.

The Word catheter is typically left in place 4-6 weeks, though it often falls out sooner. If it has not fallen out by 6 weeks, it needs to be deflated by a healthcare provider before pulling it out.

Incision and drainage (and fistulization) with Jacobi Ring insertion

This is very similar to the insertion of a Word Catheter. After the skin has been cleaned and anesthetized (“numbed”), two small cuts are made over the abscess. A very small tube (cut from a Foley Catheter) is inserted through one opening in the abscess and out the other. The two ends are sewn together (“sutured”), forming a ring.

The Jacobi Ring is left in place for a few weeks to allow additional pus to drain. This is a good option when fistulization is desired but a Word catheter is not available.

Marsupialization

If you have had recurrent Bartholin Gland Abscesses, you may be a candidate for marsupialization. This is typically performed by a Gynecologist in either a clinic or operating room setting. The skin is cleaned and topical anesthetic (i.e. lidocaine) is injected. An incision is made over the Bartholin Gland abscess site (on the inner part of the labia minora). The abscess cavity is turned inside out and sewn (“sutured”) down with dissolvable stitches. This inside out cavity will slowly close over several weeks.

Which treatment is right for me?

Here are some questions to consider asking yourself and your HCP to guide your decision:

  • Post-menopausal patients likely require a tissue biopsy (and in some centers age >40). This may mean a Gynecologist needs to see you for the procedure.

  • If it is the first episode, drainage/fistulization is very reasonable. If you have experienced many episodes, you may be a candidate for marsupialization.

  • If your previous drainage was successful (symptoms resolve quickly), you may still be a candidate for drainage now. If you are getting episodes close together with drainage, consider if marsupialization is an option.

  • If your previous method of drainage was successful, the same treatment can be considered again. If you did not have good success, ask your HCP if another option is possible.

  • Depending on where you live, incision and drainage (with or without a Word catheter or Jacobi Ring) may be the only feasible option.

  • Many HCPs are very comfortable with a “simple” Incision & Drainage. Some may be equally comfortable inserting a Word catheter or Jacobi Ring. Not all health centers/hospitals have access to a Word catheter or the supplies to create a Jacobi Ring.

  • It is generally recommended not to engage in sexual activity or wear very tight-fitting clothes while a Word Catheter is in place. This may be up to 6 weeks.

  • If you have a Word catheter inserted, you should have a follow-up appointment in 4-6 weeks with a healthcare professional for catheter removal and to check on healing. If you will not be able to have a follow-up (whether due to travel, geography, etc), this may not be the right choice for you.

  • The stem of the Word catheter is made of latex, so it is not a suitable option for you. Tell your HCP if you have a latex allergy.