Bartholin’s cyst or abscess

Causes

A Bartholin's abscess forms when a small opening (duct) from the gland gets blocked. Fluid in the gland builds up and may become infected. Fluid may build up over many years before an abscess occurs.

Often the abscess appears quickly over several days and become very hot and swollen. Activity that puts pressure on the vulva, and walking and sitting, may cause severe pain.

Symptoms

• A tender lump on either side of the vaginal opening
• Fever
• Pain with sexual intercourse

Exams and Tests

A pelvic exam reveals an enlarged and tender Bartholin's gland. A biopsy may be recommended in older women to look for a tumor, although this is very rare.

Any vaginal discharge or fluid drainage will be sent to a lab for analysis.

Treatment

Soaking in warm water four times a day for several days usually provides some relief and causes the abscess to open and drain on its own. However, the opening is usually very small and closes quickly, so the abscess often returns.

DRAINAGE OF THE ABSCESS

A small surgical cut can completely drain the abscess. This relieves symptoms and provides the fastest recovery.

• The procedure can be done under local anesthesia in a doctor's office.
• A catheter (tube) may be inserted and left in place for 4 - 6 weeks to continue to allow draining while the area heals.
• You should begin soaking in warm water 1 - 2 days afterward. You cannot have sexual intercourse until the catheter is removed.

Antibiotics may be prescribed, but they are not usually needed if the abscess is drained properly.

MARSUPIALIZATION

Women who have repeated abscesses may consider a minor surgical procedure called marsupialization.

• The procedure involves creating a small, permanent opening to help the gland drain.
• The procedure may need to be done under general anesthesia in a hospital.
• You should begin soaking in warm water 1 - 2 days afterward. You cannot have sexual intercourse for 4 weeks after surgery.
• You can use oral pain medicines after the procedure, including narcotics if you need them.

Your health care provider may recommend that the glands be completely removed if abscesses keep coming back.

Outlook (Prognosis)

The chance of a full recovery is excellent. About 10% of the time, abscesses return.

It is important to treat any vaginal infection that is diagnosed at the same time as the abscess.

When to Contact a Medical Professional

Call your health care provider if:

• You notice a painful, swollen lump on the labia near the vagina opening and it does not improve with 2 - 3 days of home treatment
• Pain is severe and interferes with your normal activity
• You have one of these cysts and develop a fever higher than 100.4 degrees Fahrenheit

Alternative Names

Abscess - Bartholin's; Infected Bartholin's gland

References

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 23.

Butler KH. Incision and drainage. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 37.

Update Date: 5/31/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.