If the Bartholin's cyst is small and does not cause any symptoms, it's often better to leave it alone. However, you should still see your GP if you notice a lump.
If you have pain around the cyst, your GP may recommend that you:
- soak the cyst for 10-15 minutes in a few inches of warm water (it's easier in the bath) - you may do this several times a day for three or four days
- hold a warm compress (a flannel or cotton wool warmed with hot water) against the area
- use pain relief, such as paracetamol or ibuprofen
Always read the manufacturer's instructions when using over-the-counter (OTC) medication.
Treating an abscess
If the cyst becomes an abscess (a painful collection of pus), you may also be prescribed antibiotics to clear the infection.
Once the infection has been treated, your GP may still feel it necessary to drain the cyst, particularly if the abscess is large.
Draining a cyst
Drainage/balloon catheter insertion
When a Bartholin's cyst or abscess is inflamed, it may simply be cut open and drained if this is possible.
An alternative procedure for draining a cyst is known as balloon catheter insertion, or sometimes catheter placement or fistulisation.
This procedure is used to drain the fluid from the abscess or cyst and to create a permanent passage to drain away any future fluid that builds up.
You will have balloon catheter insertion as an outpatient, which means you won't need to stay in hospital overnight. It can be carried out under either local or general anaesthetic.
During the procedure, a cut is made in the abscess or cyst and the fluid is drained. A specially designed balloon catheter is inserted into the empty abscess or cyst. A balloon catheter is a thin, plastic tube with a small, inflatable balloon on one end.
The balloon is then filled with a small amount of salt water. This increases the size of the balloon so that it fills the cyst or abscess. If you have any pain, some of the solution can be removed to reduce the pressure slightly.
A 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 place 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 is drained and the balloon catheter removed.
A few small studies have reported that, after balloon catheter insertion, 83-97% of women healed well and their cysts or abscesses did not reoccur.
Possible complications of balloon catheter insertion include:
- pain from the catheter
- pain during sex
- swelling of the labia (the lips around the opening of the vagina)
If a cyst or abscess keeps coming back, a surgical procedure known as marsupialisation may be used. In marsupialisation, the cyst is opened with an incision and the fluid is drained out.
The edges of the skin are then stitched in a way that prevents further fluid build-up by allowing it to drain out. This creates a pouch (similar to a kangaroo's pouch, hence the name marsupialisation).
Marsupialisation is often carried out as a day case, so you will not have to stay in hospital overnight. It can be carried out under:
local anaesthetic, where the area is numbed so you cannot feel anything but you remain conscious throughout the procedure
general anaesthetic, where you are unconscious and cannot feel anything
Although complications after marsupialisation are rare, they can include:
- the abscess reoccurring
- pain - you may be given painkillers to ease any pain in the first 24 hours after the procedure
Bartholin's cyst removal
In some cases, it may be necessary to remove the Bartholin's cyst. This procedure is often considered to have the best long-term benefits, but requires an overnight stay in hospital.
There is also a higher risk of complications when the whole cyst is removed, including bleeding or blood collecting in the wound (haematoma).
These procedures are alternative ways of treating a Bartholin's cyst, but are rarely used or are not widely available.
Silver nitrate gland ablation
Silver nitrate is a mixture of chemicals sometimes used in medicine to cauterise (burn) blood vessels to stop bleeding. In silver nitrate gland ablation, a small solid stick of silver nitrate, which is 0.5cm wide and 0.5cm long, is used.
An incision 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 or 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 when it is first used. One small study reported that this occurs in 20% of women.
Carbon dioxide laser
A laser is used to create an opening in the skin of your vulva so that the cyst can be drained. The cyst can then be:
- destroyed using the laser
- left attached but with a hole in it
During needle aspiration, a needle is used to drain the cyst.
Sometimes, this is combined with a procedure called alcohol sclerotherapy, where the cavity is then filled with a liquid that is 70% alcohol. This is left in the cyst cavity for five minutes and then drained out.