No treatment is needed if the Bartholin’s cyst is small and is not causing any symptoms. However, women who have started the menopause are always advised to have a biopsy taken (see Diagnosis). If the cyst is causing some pain, your GP may advise:
- having warm baths,
- using a warm compress (cloths or cotton wool warmed with hot water) held against the area, or
- using pain relief, such as paracetemol or ibuprofen. Always read the manufacturer’s instructions when using over-the-counter (OTC) medication. Children under 16 years of age should not be given aspirin.
If the cyst becomes an abscess (a painful collection of pus), you may be prescribed antibiotics to clear the infection.
Making an incision (cut) in the cyst and draining the fluid out is not recommended because the cyst will often return. There are now a number of surgical options for treating large, painful cysts and abscesses.
Balloon catheter insertion
Balloon catheter insertion is also sometimes known as word catheter placement or fistulisation.
This procedure is used to drain the fluid from the abscess or cyst and to create a fistula (passage) to drain away any future fluid that builds up. The surface of the fistula is epithelialised (new cells grow over it to heal it), but the passage remains open.
Balloon catheter insertion is carried out on an outpatient basis, which means that you will not need to stay in hospital overnight. It can be carried out under either:
- local anaesthetic, where the area is numbed so that you cannot feel anything during the procedure but you remain conscious throughout, or
- general anaesthetic, where you are unconscious and unable to feel anything.
During balloon catheter insertion, an incision (cut) is made into the abscess or cyst and the fluid is drained. A specially designed balloon catheter (a thin, plastic tube with a small, inflatable balloon on one end) is inserted into the empty abscess or cyst through the incision.
The balloon is then filled with a small amount of saline solution (salt water). This increases the size of the balloon so that it fills the cyst or abscess. If you experience any pain, some of the solution can be removed from the balloon to reduce the pressure slightly.
A suture (stitch) may be used to partially close the incision and the balloon catheter is held in place in the cyst.
The catheter will stay in the incision while new cells grow around it (epithelialisation). This heals the surface of the wound but leaves a passage in place. This usually takes around four weeks, although in some cases it may take longer. After epithelialisation, the balloon will be drained and the balloon catheter removed.
A few small studies have reported that, after balloon catheter insertion, 83-97% of women healed well and did not have any reoccurrence of cysts or abscesses.
Possible complications of balloon catheter insertion include:
- pain from having the catheter left in,
- pain during sexual intercourse,
- swelling of the labia (the fleshy lips around the opening of the vagina),
- infection,
- the abscess reoccurring,
- bleeding, and
- scarring.
Alternative procedures
A number of other possible surgical procedures can be used to treat Bartholin’s cyst. These procedures are all performed under local anaesthetic, on an outpatient basis, and take around 15-20 minutes. Healing usually takes around two weeks and the possible complications are the same as those listed above.
Marsupialisation
In marsupialisation, the cyst is opened with an incision (cut) and the fluid is drained out. The edges of the skin are then stitched back together in a way that allows any further fluid build-up to continue to drain out.
Silver nitrate gland ablation
Silver nitrate is a mixture of chemicals that is sometimes used in medicine, for example to cauterise (burn) the ends of blood vessels to stop them bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.
During the procedure, an incision (cut) is made in the skin of your vulva (your external sexual organs) and the wall of the cyst or abscess. The cyst or abscess is then drained and the stick of silver nitrate is inserted into the cavity (the empty space that is left after draining the fluid).
The silver nitrate causes the cyst cavity to form into a small, solid lump. After two to three days, the piece of silver nitrate and the cyst cavity are removed or they may fall off on their own.
It is possible for the silver nitrate to burn some of the skin of your vulva on the first day that it is inserted. One small study reported that burning of the mucous membrane (the moist lining) of the vulva occurs in 20% of women.
Carbon dioxide laser
Another procedure involves using a laser to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then either be:
- removed,
- destroyed using the laser, or
- left attached, but with a hole in it.
Needle aspiration
During needle aspiration, a needle is used to drain the cyst.
Alcohol sclerotherapy
During alcohol sclerotherapy, a needle is used to drain the cyst and the cavity is filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and is then drained out.
Gland excision
Gland excision is the removal of Bartholin’s gland. The procedure can take up to an hour to complete.
Reoccurrence
The rate of reoccurrence of a cyst or abscess after one of these procedures is, on average, around 20%. One study of needle aspiration found the reoccurrence rate to be 38% and one study of marsupialisation found no reoccurrences.
