Where the abscess is discharging and the patient is systemically well, conservative management may be considered. Treatment with appropriate antibiotics should be given. This may be successful but does have a high rate of recurrence and would not work for large abscesses.
Incision, drainage and marsupialisation
As with any abscesses definitive management is via incision and drainage. A 1.5–2.0-cm incision is made just distal to the hymeneal ring and the abscess drained under general anaesthetic, with marsupialisation (suturing of the cyst capsule edges to the external incision edges, to prevent closure of the incision and reformation of the abscess, and to maintain duct patency). Over time, this newly created tract shrinks and re-epithelialises.
Initial incision is made over the medial aspect of the abscess to minimise scarring and allow drainage of gland secretions into the vagina. A microbiology swab should be taken from the cavity to help guide anti-microbial management.
Recurrent or chronic abscesses may need loculations broken down and large abscess cavities may need temporary packing with ribbon gauze for haemostasis.
Excision of the gland at the time of abscess drainage is technically difficult and is not recommended. It is performed if the abscess is refractory to treatment with marsupialisation or there is suspicion of carcinoma.
Antibiotics should only be used where there is surrounding cellulitis. In most cases, drainage of the pus is sufficient management.
Complications from Bartholin's abscess surgery
- haematoma formation
- damage to the rectum
- cosmetic disfigurement
- scar tissue and dyspareunia
- poor vulval lubrication
- abscess recurrence risk (up to 20%).