Information
Bartholin’s duct cysts are the most common cysts of the labia minora, occurring in about 2% of women. Abscesses are 3 times more common than cysts. Infection of a Bartholin’s gland or cyst results in the development of an abscess. Symptoms may include vulval/vaginal swelling, pain, pyrexia or dyspareunia.
Treatment Options
A small, asymptomatic cyst can be managed conservatively with a bath or warm compress to encourage drainage.
- Spontaneous drainage
If the cyst or abscess has ruptured and pus is draining, take a swab for culture to guide or indicate antibiotics if this fails to resolve spontaneously. Patient with surrounding cellulitis around the gland usually benefit from antibiotics (see recommendations below). No further treatment or follow-up is usually required.
- Medical treatment
Antibiotics may be used if there is evidence of cellulitis around the Bartholin gland.
Antibiotic Recommendation
Recommended total duration: 5 days
Recommended Antibiotic: Co-amoxiclav 625mg every 8 hours orally.
Penicillin Allergy: Co-trimoxazole 960mg every 12 hours orally AND
Metronidazole 400mg every 8 hours orally.
Pregnancy: Amoxicillin 1g every 8 hours orally AND
Metronidazole 400mg every 8 hours orally.
Pregnancy & Penicillin Allergy: Cephalexin 500mg every 8 hours orally AND
Metronidazole 400mg every 8 hours orally
- Surgical intervention or Insertion of a Word Catheter remain the mainstay of treatment for symptomatic cysts and abscesses.
Full guideline available Microsoft Word – Bartholin Cyst (scot.nhs.uk)
Who to refer:
Symptomatic abscesses that have not responded to medical treatment or patients that are systemically unwell, refer to the on-call Gynae registrar at RIE or SJH via switchboard.
Recurrence of Bartholin’s cyst/abscess before full resolution following prior spontaneous discharge/medical/surgical management, refer to the on-call Gynae registrar at RIE or SJH via switchboard.
Post menopausal women with Bartholin’s abscess, refer to the on-call Gynae registrar at RIE or SJH via switchboard.
Patients with inactive, bothersome cysts which haven’t resolved with conservative management can be referred for a routine Gynaecology outpatient clinic via SCI gateway.
Who not to refer:
Spontaneously discharging abscess with treated, or absent cellulitis.
Asymptomatic Bartholin cysts.
Patient Information leaflet: NICE Interventional Procedure Guidance No323. Balloon catheter insertion for Bartholin’s cyst or abscess. December 2009
