Recallab › Question bank › Gynaecology › #50286
Bartholin abscess
A 26-year-old woman has a painful, tense, fluctuant swelling in the posterior part of the right labium majus, making walking and sitting difficult. She is afebrile. What is the most appropriate management?
- correctA. Marsupialisation or insertion of a Word catheter
- B. Complete excision of the gland
- C. Oral antibiotics alone and review in a week
- D. Simple incision and drainage alone
Explanation
Key fact
Simple incision and drainage recurs, because the duct reseals. Marsupialisation or a Word catheter keeps a new opening patent while it epithelialises.
Marsupialisation or a Word catheter. Both create a permanent drainage tract rather than merely emptying the cavity.
Why
The gland lies at the posterior introitus, at 4 and 8 o'clock.
Its duct obstructs, the secretion accumulates, and infection turns the cyst into an abscess.
Draining it relieves the pain, but the duct then reseals and it recurs.
Marsupialisation sutures the cyst wall to the skin, leaving a permanent opening.
A Word catheter is a small balloon left in place for 4 to 6 weeks, doing the same job.
Antibiotics are added only if there is surrounding cellulitis or systemic illness.
Why simple drainage is not enough
Why not the others
- B. Complete excision of the gland — is reserved for recurrent abscesses that have failed conservative treatment, and for suspected malignancy. It risks bleeding and dyspareunia.
- C. Oral antibiotics alone and review in a week — will not resolve a tense abscess. A collection must be drained.
- D. Simple incision and drainage alone — relieves symptoms immediately but recurs in a large proportion, because the duct closes again.
Remember
Drain it and keep it open. The recurrence is a plumbing problem, not an infection problem.
Go deeper
Send a swab: gonococcus and chlamydia may be present, and their identification means partner treatment and screening for other infections.
In a woman over 40, a Bartholin mass should be biopsied or excised because of the small risk of carcinoma of the gland.
An asymptomatic Bartholin cyst in a young woman needs no treatment at all.
DC Dutta's Textbook of Gynecology, 9th ed. (Jaypee, 2023); Williams Gynecology, 4th ed. (McGraw Hill, 2020).