# Bartholins Cyst or Abscess Drainage

## Overview

This module describes how to manage a Bartholin’s cyst/abscess where incision and drainage is indicated.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“The swelling that has formed on the inner lip of your vagina is a cyst or abscess that has formed in a normal gland. It’s not clear why this happens. I need to make a small cut to drain the pus, then place a short piece of tubing that will remain in place for a month.”

### What can my patient expect?

“This is a relatively quick procedure. I will give you an injection that will numb the area before I make the cut and place the tubing. You may feel pressure and tugging when I work there, and this will be uncomfortable.”

### What is my patient’s role?

“Let me know if you have any allergies, a heart condition, a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep as still as possible. If you feel strange sensations like tingling or severe pain, tell me immediately. Afterwards you will need to sit in a bath of warm salt water a few times a day to assist with the healing. Come back in a month to have the tubing removed, and while it is in, abstain from sexual intercourse.”

## Preparation

###

### Documentation

1. Patient notes

### Equipment

## Site & Positioning

Position the patient in lithotomy. This procedure requires strong, focused lighting.

## Procedure

Follow medical asepsis with sterile gloves.

### For placement of a Jacobi ring

1. Perform steps 1-12 as above.
2. Tunnel the haemostat or curved forceps through the cyst and make a second incision on the other end of the cyst for the tip of the haemostat or curved forceps to exit.
3. Grasp the one end of the Jacobi ring with the haemostat or curved forceps.
4. Pull the Jacobi ring through the abscess cavity, ensuring that the suture is not pulled out of the catheter.
5. Tie the two ends of the sutures, which forms a closed ring.
6. The Jacobi ring is removed on follow-up after 3 weeks.

### For marsupialization

1. The initial procedure is the same as for incision and drainage.
2. Grasp the edge of the incision with a forceps and evert the edge.
3. Using absorbable interrupted sutures, suture the edges onto the adjacent epithelial surface, starting first with one side of the incision then the other, so that the cavity stays open.
4. Pack the cavity with topical antibiotic cream or iodine soaked gauze.

## Troubleshooting

I do not have stirrups at my disposal.

The patient should be positioned reclining or supine, with their heels drawn up to their buttocks and knees apart.

I want to make a Jacobi ring.

Use a 7cm length of a size 8 French T tube, and thread approximately 20cm of 2-0 silk suture material through the middle of the tube. Alternatively, a 5 cm length of butterfly needle tubing can be used with absorbable (Vicryl) suture material threaded through the lumen.

I do not have theatre facilities available.

If the cyst walls can be identified, marsupialisation in theatre is the preferred treatment. If unable to perform, relieve the abscess first, then electively do the marsupialisation.

The cyst appears to be under high pressure and I’m worried about splash exposure.

Wear appropriate PPE, including eye protection, a facemask, and an apron. You may partially drain the cyst with a needle and syringe prior to excision. Don’t fully drain the cyst as this will make incision more difficult.

## Risks

1. Haemorrhage
2. Postoperative dyspareunia
3. Infections
4. Excessive scarring secondary to marsupialization
5. Sharps injury to healthcare personnel

## References

1. Lee WA, Wittler M. Bartholin Gland Cyst. [Updated 2022 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532271/
2. Blitz-Lindeque J. How to treat a bartholin’s cyst or abscess. In: Mash B, Blitz-Lindeque J, eds. South African Family Practice Manual. 2nd ed. Pretoria: Van Schaik Publishers; 2010: 302.
3. Omole F, Kelsey RC, Phillips K, Cunningham K. Bartholin Duct Cyst and Gland Abscess: Office Management. Am Fam Physician. 2019;99(12):760-766. Available from: https://www.aafp.org/afp/2019/0615/p760.html
4. Gennis, Li, S. F., Provataris, J., Shahabuddin, S., Schachtel, A., Lee, E., & Bobby, P. Jacobi ring catheter treatment of Bartholin’s abscesses. The American Journal of Emergency Medicine. 2005;23(3):414–415. https://doi.org/10.1016/j.ajem.2005.02.033