Various Treatment Options Available for Large Bartholin Cyst

Douglas Creedon, M.D., Ph.D., Obstetrics and Gynecology

DEAR MAYO CLINIC: I'm 19, and I've had a golf-ball-sized Bartholin cyst for two years. I have only mild discomfort. I've tried sitz baths for relief but would like to know if I should get the cyst drained. I've been told it would only leave me open to more infections. Are there other options?

ANSWER: Treatment of a Bartholin cyst depends largely on the symptoms you're experiencing. These cysts are formed when one of the Bartholin glands, located on either side of the vaginal opening, becomes obstructed.

Why these glands become blocked is not entirely clear. Although most Bartholin cysts don't cause problems, the cyst you describe is large. If a Bartholin cyst is causing irritation with your general activities, such as walking, running or riding a bike, or if you are sexually active and it is causing pain during sexual intercourse, then it's reasonable to want to treat it.

Bartholin glands supply mucus or moisture to the vagina. When a gland opening is blocked, fluid builds up within the gland, forming a cyst. Such cysts occur primarily in premenopausal women under age 40. If a Bartholin cyst is detected in a woman over 40, current recommendations are that the cyst should be biopsied, because in a very small percentage of cases, cancer can be the cause.

Typically, most Bartholin cysts are benign and small -- pea-sized, for example. And most are relatively painless. If a small cyst is tender, I might recommend soaking in warm water (a sitz bath) several times a day for several days, as you've mentioned. This can alleviate some discomfort and may help the cyst drain on its own.

For larger or infected cysts, there are several surgical options. All include draining the cyst first, and then treating any infection.

Surgical drainage involves making an incision in the cyst to drain it. This usually provides immediate relief of pressure symptoms, but once the incision closes there is a risk of reaccumulation of fluid.

To prevent closure and cyst reoccurrence, a small drainage tube with a balloon tip (a Word catheter) can be inserted into the incision. The catheter is then left in place for several weeks to create a new duct or outlet for the gland. Incision and placement of a drainage tube can be done under local anesthesia in your doctor's office. If the cyst is infected (abscessed), your doctor may also prescribe antibiotics.

Another option is a surgical procedure called marsupialization. An incision is used to remove part of the gland and stitch the exposed rim of the gland to the skin. This bypasses the normal duct and provides a bigger channel to keep the gland open.

If the entire gland is exposed through marsupialization, it may stop functioning as a gland and over time become, essentially, new skin. Other glands in the vulva will continue to supply moisture to the area. While marsupialization is a more involved procedure than placement of a Word catheter, it can usually still be done in the doctor's office under local anesthesia or with a regional nerve block.

In instances of recurring and serious infections, removing the gland entirely may be advisable. This surgery is more involved and is typically done in a surgical suite. Since this procedure carries increased risk of bleeding and scarring, gland excision should be reserved for recurrent symptomatic cysts.

Douglas Creedon, M.D., Ph.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

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