Surgery

• For Bartholin abscesses and cysts that are symptomatic (large or painful), the treatment is drainage. An abscess is an infection within an enclosed space, and antibiotics do not adequately enter into the enclosed space. Therefore, treatment of an abscess almost always requires that the infection be drained.
  
  
  • Drainage of a Bartholin abscess can be done in the doctor's office or a hospital's Emergency Department. Local anesthetic is injected over the abscess, and then an incision is made on the inner surface of the entrance to the vagina. After the infected material is drained, the abscess cavity is packed either with gauze or a small catheter. This holds the cavity open and promotes further drainage. Gauze packing is removed after 24-48 hours. If a small catheter is used, it may be left in place for several weeks to minimize the chance of recurrence.
    
    
  • Drainage of an abscess can be uncomfortable, because local anesthetics do not always work well in inflamed tissue. Depending on the preferences of both the woman and the doctor, as well as other factors including the size of the abscess, IV medications may be given for sedation and additional pain relief during the procedure.
    
    
  • After drainage of an abscess, antibiotic treatment is usually not necessary. However, if there is a concern of a sexually transmitted infection, or if there is evidence of urinary or vaginal infection, an antibiotic may be prescribed. In some cases, this will be done a couple of days after the initial treatment, after the results of any cultures are received.
  
  

Once a recurrent cyst has been cooled off, a procedure called a marsupialization can be carried out. This is usually done in an outpatient surgical setting. An incision is made into the skin over the cyst and then carried down through the cyst wall. This drains the fluid from the cyst and then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent drain site. This usually prevents recurrence of the cyst.