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Clinical Procedures > Obstetric and Gynecologic Procedures
Drainage, Bartholin Abscess
Article Last Updated: Dec 10, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 13  
Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Editors: Andrew K Chang, MD, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital; Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Author and Editor Disclosure
Synonyms and related keywords:
Bartholin abscess, Bartholin cyst, Word catheter, Bartholin gland drainage, Bartholin gland swelling, incision and drainage, abscess drainage, cyst drainage, Bartholin gland
The Bartholin glands are a pair of pea-sized, vulvovaginal, mucous-secreting vestibular glands that are located in the labia minora in the 4- and 8-o’clock positions, beneath the bulbospongiosus muscle. A Bartholin cyst is a fluid-filled sac that develops in one of the Bartholin glands or ducts when the duct that drains the fluid from the gland becomes blocked and causes the duct and gland to swell. A Bartholin gland abscess develops either when a Bartholin cyst becomes infected or when the Bartholin gland itself becomes infected. For more information on disorders of the Bartholin gland, please see Bartholin Gland Diseases and Benign Vulvar Lesions.
Different techniques exist for the treatment of Bartholin cysts and abscesses.1 Use of the Word catheter is favored.2, 3 If a Word catheter is not available, incision and drainage (with traditional packing) may be performed.
- Selected Bartholin cysts
- Diameter of 1 cm or larger
- Any symptomatic cyst (painful, tender, interferes with physical or sexual activity)
- Any Bartholin abscess
- Absolute - None
- Relative - Complex or recurrent abscess that requires general anesthesia in the operating room
- Incision and drainage of a Bartholin cyst or abscess requires anesthesia of the labial mucosa. Because infiltration of the labial mucosa with a local anesthetic may be painful, discuss options such as intravenous narcotics and procedural sedation and analgesia with each patient.
- See Technique for the procedure for local anesthetic infiltration. For more information, see Local Anesthetic Agents, Infiltrative Administration.
- Sterile skin preparatory solution and drapes
- Lidocaine 1%
- Syringe, 3 mL
- Syringe, 5 mL
- Syringe, 10 mL
- Needles, 18 gauge (3)
- Needle, 25 gauge
- Scalpel blade (No. 11) and handle
- Gauze pads (4 X 4)
- Hemostat
- Culture swab
- Word catheter
Word catheter.
Word catheter with inflated balloon.
- Place the patient in the lithotomy position.
- Explain the procedure, risks, benefits, possible complications, alternative options, and postprocedure care to the patient or her legal representative and obtain a written informed consent. A female chaperone should be present in the procedure room throughout the procedure.
- Place the patient in the lithotomy position and spread open the labia. An assistant may aid with traction of the labia during the procedure.
Bartholin abscess. - Use the sterile skin preparatory solution to clean the labia and surrounding area.
Skin preparation. - Infiltrate 2-3 mL of lidocaine 1% subcutaneously under the mucosa of the labia minora.
Mucosal infiltration with lidocaine.
Mucosal infiltration with lidocaine. - Large abscesses or cysts may be needle-decompressed prior to incision with the blade.
Needle aspiration.
Needle aspiration. - Use the No. 11 blade to make a 0.5 cm–long puncture into the abscess or cyst cavity on the mucosal surface of the labia minora. Make the incision within the hymenal ring, if possible.
Incision of Bartholin abscess.
Incision of Bartholin abscess. - Express the contents of the sac manually and use the hemostat to break adhesions. The contents may be sent for culture, and a suction system can be used to contain the manually-expressed fluids.
Drainage of a Bartholin abscess. - Insert the tip of the Word catheter deep into the abscess cavity and use 2-4 mL of normal saline to inflate the balloon.
Insertion of a Word catheter.
Inflation of a Word catheter.
Insertion and inflation of a Word catheter. - Tuck the free end of the catheter into the vagina. In many cases, the free end changes its position to protrude outside the vagina. The catheter should stay in place for up to 4 weeks to allow epithelization of the tract. The patient should abstain from vaginal intercourse while the catheter is in place.
Word catheter in place.
- Antibiotic treatment is at the discretion of the treating physician. Antibiotics are not usually indicated in the immunocompetent patient with a drained Bartholin abscess.
- When a Word catheter is not available, a simple incision and drainage with packing can be performed. Warn the patient of the high probability of abscess recurrence and refer the patient to a gynecologist.3 Change of the packing 2 days postprocedure is usually recommended.
- All patients should be instructed to begin sitz baths 1-2 days postprocedure and to abstain from vaginal intercourse until the Word catheter or packing is removed.
- Prescribe analgesics and refer patients to a gynecologist for follow-up.
- Patients older than 40 years should be referred to a gynecologist for a biopsy to rule out Bartholin gland cancer.
- Patients with multiple recurrences with previous treatments should be referred to a gynecologist for definitive treatment (complete excision).
- Recurrence
- Recurrence is the most common complication after incision and drainage.
- Premature dislodgement of the Word catheter results in incision closure and high rates of recurrence.
- Missed diagnosis of Bartholin duct carcinoma
- This rare form of carcinoma has an approximate incidence of 0.1 cases per 100,000 women.
- Women older than 40 years should be referred to a gynecologist for diagnosis and treatment.4
- Bleeding
- Progressive infection and sepsis5 (For more information on sepsis, visit Medscape's Sepsis Resource Center.)
- Patients with compromised immune systems may exhibit these rare complications.
- Treat all immunocompromised patients with antibiotics. Closely monitor or even admit such patients in order to diagnose and treat progression to a deeper-seated infection.
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.
- Marzano DA, Haefner HK. The bartholin gland cyst: past, present, and future. J Low Genit Tract Dis. Jul 2004;8(3):195-204. [Medline].
- Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician. Apr 1 1998;57(7):1611-6, 1619-20. [Medline]. [Full Text].
- Omole F, Simmons BJ, Hacker Y. Management of Bartholin's duct cyst and gland abscess. Am Fam Physician. Jul 2003;68(1):135-40. [Medline].
- Gadducci A, Cionini L, Romanini A, Fanucchi A, Genazzani AR. Old and new perspectives in the management of high-risk, locally advanced or recurrent, and metastatic vulvar cancer. Crit Rev Oncol Hematol. Dec 2006;60(3):227-41. [Medline].
- Lopez-Zeno JA, Ross E, O'Grady JP. Septic shock complicating drainage of a Bartholin gland abscess. Obstet Gynecol. Nov 1990;76(5 Pt 2):915-6. [Medline].
- Cunningham G, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 22nd ed. New York, NY: McGraw-Hill; 2005.
- Lindsay K. Reichman E, Simon RR, eds. Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2004.
Drainage, Bartholin Abscess excerpt Article Last Updated: Dec 10, 2007
Topic originally published: Mar 8, 2006
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