Bartholin Gland Disorders: A Comprehensive Review

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

Bartholin Gland Disorders — Cyst, Abscess & Recurrence

Bartholin gland swellings are common and usually benign. This sheet gives how to tell a cyst from an abscess, when to swab and when to biopsy, how to drain so that it does not recur, and how to counsel.

🎯 AT A GLANCE — BARTHOLIN GLAND DISORDERS

The Bartholin glands are a pair of mucus-secreting glands at the base of the labia minora, at the level of the hymen; their ducts open at about 4 and 8 o’clock

A blocked duct forms a cyst; an infected cyst forms an abscess; about 3% of women are affected in their lifetime (NHS GGC)

A cyst is often painless; an abscess is painful, red and tender, and may bring fever

The usual germ is E. coli; others are Staph. aureus, group B streptococci and enterococci; gonorrhoea is sometimes found

Over 70% of cysts and about a third of abscesses grow no germ, so not every cyst needs an antibiotic

After 40, consider a biopsy: Bartholin gland adenocarcinoma is rare but real

Drain with a Word catheter or marsupialise, rather than just cutting and leaving it; check for infection before giving an antibiotic; and biopsy any hard lump or any new lump after 40.

🚨 DO NOT JUST DRAIN — BIOPSY OR REFER IF…

She is over 40 — consider a biopsy because of the risk of adenocarcinoma of the Bartholin gland

The lump is hard, fixed, irregular or ulcerated, at any age — biopsy and refer to a gynaecological oncologist (from memory)

Cellulitis spreads, or she has fever and feels ill — treat with antibiotics and drain; admit if unwell, or if diabetic or immunosuppressed (from memory)

The abscess recurs — marsupialisation; consider excision of the gland if it keeps returning

There may be a sexually transmitted infection — send chlamydia and gonorrhoea swabs

She is in the first trimester — do not give co-trimoxazole

STEP 1 · RECOGNISE — what it looks like and what else it may be

🔍 CYST OR ABSCESS?

	Bartholin cyst	Bartholin abscess
Onset	Slow; often found by chance	Rapid, over a few days (from memory)
Pain	None, or discomfort on sex, walking or sitting	Severe, throbbing; hard to sit or walk
On examination	Non-tender, smooth swelling at 4 or 8 o’clock	Tender, red, hot, tense swelling; may drain by itself; cellulitis may track out
General	Well	May have fever

🧐 WHAT ELSE IT MAY BE

Look-alike	How it differs
Inclusion or sebaceous cyst	In the skin, often with a punctum; not at the 4 or 8 o’clock position of the duct (from memory)
Gartner duct cyst	Higher, on the side wall of the vagina (from memory)
Haematoma	Sudden, bruised, after injury (from memory)
Hidradenitis suppurativa	Repeated nodules and scars in the groin, armpits or buttocks (from memory)
Lipoma, endometriosis	Soft, painless lump; or cyclical pain (from memory)
Bartholin gland cancer	Hard, fixed or irregular mass; older women; biopsy

🩺 AT THE FIRST VISIT

Ask when it began, about pain, fever, discharge, pain on sex and earlier episodes; diabetes, immunity, and pregnancy (from memory)

Examine the vulva: the position, size, tension, tenderness, hardness, and redness of the skin around it (from memory)

Take a charcoal swab from the cyst or abscess for culture and sensitivity

Send chlamydia and gonorrhoea swabs if there is any risk of a sexually transmitted infection

Previous swabs help choose an antibiotic

Offer a biopsy if she is over 40 or the mass looks suspicious

STEP 2 · TREAT — choose by symptoms, infection and recurrence

🧭 FROM SWELLING TO TREATMENT

💊 TREATMENT OPTIONS

Option	How it is done	Notes
Warm baths and pain relief	Hot sitz baths several times a day; paracetamol or ibuprofen	For small, mild cysts; no antibiotic unless there is cellulitis
Word catheter (first line)	Under local anaesthetic (optional) make a 5 mm stab incision on the mucosa just outside the hymen; inflate the balloon with no more than 3 mL of saline; use an anchor suture if the cut is too large	Stays in about 4 weeks (2 to 3 weeks in some units); if it falls out and she is improving, leave it out; recurrence is about 10 to 12% at 12 months
Marsupialisation	For a recurrent abscess, or if she does not want a catheter; under general anaesthetic; packing is not routinely needed	Recurrence is about 10 to 12% at 12 months; a single dose of co-amoxiclav 1.2 g or clindamycin 900 mg intravenously before surgery
Incision and drainage, or needle aspiration	Simple drainage	Higher recurrence; avoid if possible
Excision of the gland	General anaesthetic, up to an hour	For repeated recurrence or suspected cancer; risks are bleeding, infection and scarring
Antibiotics	Only for cellulitis or offensive discharge: co-amoxiclav 625 mg 8-hourly for 5 days, or co-trimoxazole 960 mg 12-hourly for 5 days	Avoid co-trimoxazole in the first trimester; adjust to swab results and local resistance

Remember: a cyst that is not infected needs no antibiotic. Do not simply cut and leave: it nearly always comes back. Keep the opening patent with a catheter or marsupialisation.

STEP 3 · AFTERCARE AND COUNSELLING — what she needs to hear

🏠 AFTERCARE

She may carry on normal activities with a catheter in; it keeps the opening from closing so a new duct can form

Mild pain is normal; paracetamol or ibuprofen usually helps

After surgery use showers rather than baths; keep the area clean and dry; wear cotton underwear; have panty liners ready

Avoid bubble baths, lotions and talcum powder

No sex until the pain and discharge are gone and the wound is healed, usually about 2 weeks

Give her a number to call (gynaecology emergency or day unit)

🚨 TELL HER TO COME BACK IF…

Pain or swelling is increasing

She has fever or chills

The skin is red or warm around the wound

There is pus or discharge from the wound

The catheter falls out and the swelling returns

🗣️ WHAT TO TELL HER

The gland is a normal part of the body; a blocked duct is common, and it is not caused by poor hygiene (from memory)

It is not always a sexually transmitted infection; many cysts and abscesses contain no germ

It can come back, about 1 in 10 within a year after a catheter or marsupialisation, and more often after simple drainage

After 40, a biopsy is advised because cancer of the gland, though rare, can look like a cyst

The risks of surgery include infection, bleeding and scarring

⚠️ COMMON PITFALLS

Giving an antibiotic for every cyst

Cutting and draining without a catheter or marsupialisation

Missing a biopsy in a woman over 40 or a hard lump

Giving co-trimoxazole in the first trimester

Forgetting to send swabs, including chlamydia and gonorrhoea

Not securing the catheter, or not telling her what to do if it falls out

Not giving aftercare advice or a contact number

Calling every vulval lump a Bartholin cyst

Memory Aid

GLAND

Five steps for a Bartholin swelling.

G

Gland position — 4 or 8 o’clock at the base of the labia minora

L

Look for infection — cellulitis, fever, swab; antibiotic only if infected

A

Age over 40 — biopsy; hard or fixed lump at any age

N

No simple cut — Word catheter or marsupialisation

D

Defend against recurrence — aftercare, warning signs, follow-up

Remember: a cyst needs no antibiotic, an abscess needs lasting drainage, and an older woman needs a biopsy.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary. Checked against: the NHS Greater Glasgow and Clyde guideline “Management of Bartholin’s cyst and abscess” (GYN 066): anatomy, causes, swabs, antibiotic regimens, biopsy over 40, Word catheter technique, marsupialisation, recurrence of about 10 to 12% (WoMan trial) and aftercare; and the West Hertfordshire Hospitals patient leaflet on the Word catheter: duration of 2 to 3 weeks, anaesthesia, aftercare, sex and warning signs. Items marked “from memory” (look-alike descriptions, hard mass at any age, systemic illness and admission, history and examination details, hygiene, onset of abscess) were not checked. Both sources are from the United Kingdom; antibiotic choice and protocols differ in India: follow local sensitivities and your protocol.