User:Shelbyorch/Bartholin's cyst

Treatment[edit]
If the Bartholin's cyst is not painful or uncomfortable, treatment may not be necessary. Small, asymptomatic cysts can be observed over time to assess their development. Sitz baths may be useful in draining minor cysts. This is a more conservative treatment that involves soaking the vaginal area in a few inches of warm water. It is generally recommended to do this for 10 minutes at a time, up to 4 times per day. This treatment can sometimes cause cysts to spontaneously drain without further intervention (cite).

In cases that require intervention, a catheter may be placed to drain the cyst, or the cyst may be surgically opened to create a permanent pouch (marsupialization). Intervention has a success rate of 85%, regardless of the method used, to alleviate swelling and discomfort.

Catheterization is a minor procedure that can be performed locally as an outpatient procedure. A small tube with a balloon on the end (known as a Word catheter) may be inserted into the cyst. The balloon is then inflated to keep it in place. A sample may be sent to a lab for culturing and a biopsy may also be done (cite). The catheter stays in place for 2 to 4 weeks so the the fluid can drain and cause a normal gland opening to form (after which the catheter is removed). The catheters do not generally impede normal activity, but sexual intercourse is generally abstained from while the catheter is in place.

Catheterization can be performed multiple times if recurrence occurs. At this point, antibiotics will typically be given in addition to the catheter (cite). Some commonly prescribed antibiotics include Doxycycline, Azithromycin, Ciprofloxacin, and Trimethoprim/sulfamethoxazole, among many others. These antibiotics are chosen to ensure coverage of the most common pathogens including Staphylococcus (including Methicillin-resistant Staphylococcus aureus), Streptococcus, and Escherichia coli

Cysts may also be opened permanently, a procedure called marsupialization. This involves opening the gland through an incision to ensure that the secretion channel remains open. If a cyst is infected, it may break open and start to heal on its own after 3 to 4 days. Non-prescription pain medication such as ibuprofen relieves pain, and a sitz bath may increase comfort and reduce pain. Warm compresses can also speed up healing. If a Bartholin gland abscess comes back several times, the gland and duct can be surgically removed.

Recurrence

A randomized control trial (the WoMan trial) was performed in the Netherlands and England from 2010 to 2014. Women with bartholin's cysts were randomly assigned to receive treatment via Word catheter or marsupialization to compare recurrence over 1 year. This trial found that recurrence rates were quite similar between the two treatments. Recurrence occurred in 12% of women in the catheter group and 10% of women in the marsupialization group.