BARTHOLIN’S CYST OR ABSCESS What are the Bartholin’s Glands? The Bartholin glands are located on both sides of the vaginal opening. Under normal conditions they are not noticeable. Their job is to secrete a fluid that keeps the vagina moist. If the glands become infected the skin around them may become red, hot, swollen and unbearably tender. The gland may ooze with pus or, if constricted, may swell with pus to form an abscess. How is a cyst or abscess formed? A Bartholin’s gland abscess usually forms because of an infection. What is the treatment for the cyst or abscess? Treatment is not always needed If you have a small cyst that causes no symptoms and does not become infected, then it may be best simply to leave it alone. However, always report a 'lump' in the area around your vagina (your vulva) to your doctor. Do not just assume a small lump is a Bartholin's cyst. It is best for a doctor to examine you to confirm the diagnosis and to rule out other causes of lumps in the vulva. If a cyst causes symptoms then it can be treated. A Bartholin's abscess will almost always need treatment as it can be very painful. However, if an abscess is left long enough it is likely to burst and then may resolve without treatment. This is not recommended, though, as it will be very painful and you could become quite ill. Will I need tests? You may require blood tests to look for a generalised infection if you feel unwell or before your operation. If your abscess discharges pus, we may send a small sample of the pus to the lab for testing. This can show what type of germ caused the infection, and guide our choice of antibiotic. Antibiotics for an infection or abscess A course of antibiotics has a good chance of curing an infected gland or abscess. However, as a rule, the more pus that forms, the larger the abscess, the less chance that antibiotics alone will be sufficient to clear the abscess without also needing to drain the pus. Surgical Treatment The drainage of the abscess is performed under general anaesthetic in theatres. You should not eat or drink for 6 hours prior to the operation. This operation is often performed as an emergency case, but sometimes you will be booked into the day surgery unit if you are not in too much discomfort to wait for a day or two. If you are already on the ward, there may sometimes be a delay in getting to theatre as you will be placed on an emergency list and will have to wait for more urgent cases to be done first. The nurses should be able to keep you informed of this, so you have some idea of when you will be going down to theatre. The operation involves an incision of the cyst or abscess which can then be drained of any pus or fluid. The incision is then often sutured open widening the duct or opening of the gland. In addition, a small piece of packing gauze or wick is often 1 placed inside the incision. This allows adequate drainage and ensures that the wound heals quickly. The gland itself is rarely removed. On return to the ward, you will be sleepy for a while and may have some discomfort from the operation site. Pain-killers will be given as needed. Walking around can at first be a little uncomfortable. You may also experience some discomfort when you first pass urine. If there is some packing inside, you will need to stay overnight. The packing will be removed the following morning and you will be able to go home. If there is no packing inside, providing you feel well, have eaten and drunk, and passed urine, and have someone who can take you home, you will be discharged about 2 to 4 hours after surgery. You will need to continue on the antibiotics until the course is completed. Please ensure you have a supply of your usual pain killers at home. The stitches used will usually dissolve on their own after about 10 to 12 days, but occasionally it takes longer. Very occasionally, if they are pulling and the wound has healed, they may need to be removed before they have dissolved. This can usually be arranged with the practice nurse at your GP surgery. Are there any possible complications? Yes. Any operation may lead to complications, including: • excessive bleeding • surgical wound infection • injury to the nearby tissue • a recurrence of the problem In fewer than 10% of cases, surgical treatment of Bartholin’s abscess or cysts may lead to: • more wide spread infection • sepsis- when bacteria or toxins destroy tissue • scarring and pain What happens after the surgery? Once you have been discharged from hospital, you will need to rest for a couple of days. Ensure the area is kept clean and dry. Baths and showers are permitted, but you should avoid bubble bath, oils or talcum powder (which are all irritants) while the wound is healing. You should also avoid sexual intercourse until there is no discharge and you are pain free. Pain-killers may be taken as needed and you should probably avoid tight fitting clothes, e.g., jeans and tight underwear, until you are pain free. Follow up is not usually required. Will it happen again? In most cases, a Bartholin's cyst or abscess does not recur after treatment with one of the operations described above, or if antibiotics alone cured the problem. However, they do recur in some cases and treatment will need to be repeated. If you have any queries when you get home, please contact your GP or the ward: Ward 20: 01753 634535 Day Surgery unit: 01753 634570 (Monday to Friday 8am to 5pm). 2 If you would like a copy of this leaflet on audiotape, in large print or translated, please telephone 01753 634398 Title of leaflet: Bartholin’s Cyst or Abscess Reference No: L/025/3 Issue Date: March 2013 Review date: March 2016 Compiled by: Dr H Hanna (Associate Specialist), Dr V Argent (Specialist Trainee), Mr A Raafat (Consultant) Legal Notice Please remember that this leaflet is intended as general information only. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on any concerns you may have with your doctor. Heatherwood Hospital London Road Ascot Berkshire SL5 8AA Tel 01344 623333 Wexham Park Hospital Wexham Street Slough Berkshire SL2 4HL Tel 01753 633000 Web: http://www.heatherwoodandwexham.nhs.uk/ 3