Patient handout

Bartholin gland cyst / abscess (I&D + Word catheter, marsupialization for recurrent)

PRODUCTION

1. Your condition

This handout is for bartholin gland cyst / abscess (i&d + word catheter, marsupialization for recurrent). Your care team identified this based on: unilateral labial swelling at 4 or 8 oclock position with fluctuance — classic bartholin abscess (wechter 2009 pmid 19099613).

Other reasons your team may use this plan: painful vulvar mass with difficulty sitting / walking / intercourse — symptomatic bartholin abscess (wechter 2009 pmid 19099613); asymptomatic unilateral labial swelling — bartholin cyst (often incidental; observation / sitz baths if mild); recurrent ipsilateral bartholin abscess (≥ 2 episodes) — escalate to marsupialization or gland excision (wechter 2009 pmid 19099613).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
incision_and_drainage_word_catheter	—	—	—	Wechter 2009 PMID 19099613 — I&D with Word catheter (small Foley-like catheter inflated with 3-5 mL water; dwell × 4-6 wk for epithelialization) is the office-based standard; recurrence < 5 % vs 5-15 % with I&D alone
lidocaine_local_infiltration	1 % lidocaine 5-10 mL infiltrated subcutaneously over abscess	subcutaneous_infiltration	single_procedure	Local anesthesia for office I&D; 1 % lidocaine without epinephrine for vulvar tissue
acetaminophen	650-1000 mg PO	PO	q6h PRN, max 3 g/day	Post-procedure analgesia; multimodal opioid-sparing; safe in pregnancy
ibuprofen	400-600 mg PO	PO	q6h PRN, max 2.4 g/day	Effective post-procedure NSAID; avoid in pregnancy and renal impairment

Plan: Bartholin abscess — drainage primary (I&D + Word catheter); antibiotics adjunctive for systemic features / immunocompromise / pregnancy / sepsis / STI overlap (Wechter 2009 PMID 19099613; CDC 2021 PMID 34292926)

3. When to call your provider

Contact your care team if any of the following happen:

Systemic features (fever / hypotension / tachycardia / sepsis) → ED for IV antibiotics + admission
NF red flags (pain out of proportion / crepitus / bullae / rapid spread / systemic toxicity) → emergent ED + surgical consultation; Fournier mortality 25-35 %
Recurrent ipsilateral disease (≥ 2 episodes) → gyn for marsupialization (office or OR)
Postmenopausal or atypical features → gyn-onc referral if histology malignant
Pregnancy with complications → OB co-management
Word catheter premature displacement → replace OR marsupialization for repeat displacement

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptomatic fluctuant Bartholin abscess at office / clinic / ED presentation — I&D + Word catheter × 4-6 wk is definitive primary therapy; recurrence < 5 % vs 5-15 % with I&D alone (Wechter 2009 PMID 19099613)
Bartholin abscess with fever / cellulitis / immunocompromised host (HIV / DM / steroid / chemotherapy / transplant) — antibiotics adjunctive + I&D + observation (CDC 2021 PMID 34292926; Wechter 2009 PMID 19099613)
Postmenopausal patient or > 40 yr with Bartholin mass OR atypical features (firm, fixed, induration of abscess wall, persistent or recurrent disease, poor response to standard therapy) — biopsy abscess wall for malignancy ddx (Visco 1996 PMID 8559513; Heller 2014 PMID 24803013)
Bartholin abscess with extension into surrounding labial / perineal / perirectal tissue OR cellulitis OR necrotizing fasciitis red flags (pain out of proportion / crepitus / bullae / rapid spread / systemic toxicity) — broader antibiotics + surgical consultation; rule out Fournier gangrene (mortality 25-35 %) (IDSA 2014 SSTI Stevens framework)
Pregnant patient with symptomatic Bartholin abscess — drainage acceptable (no fetal risk from local procedure); antibiotic considerations modified (avoid TMP-SMX 1st trimester / late pregnancy; avoid doxycycline; prefer amox-clav OR cefuroxime + metronidazole); OB co-management (CDC 2021 PMID 34292926)

5. Follow-up

Outpatient gyn follow-up at 4-6 wk for Word catheter removal + recurrence assessment + STI test result review + treatment of asymptomatic partner if STI positive (CDC 2021 PMID 34292926). Counsel on recurrence risk + early presentation for recurrent symptoms (route to marsupialization). Pathology review for postmenopausal / atypical biopsy — gyn-onc referral if malignant (Heller 2014 PMID 24803013). Counsel on safer-sex practices if STI testing positive; HIV / syphilis screen review. Reproductive planning + contraception counseling unchanged. Postpartum coordination if peripartum.

6. Sources

Guideline: ACOG Patient Information on Bartholin gland disease (no dedicated Practice Bulletin; consolidated in patient education + Williams Gynecology Ch. 4 + Berek & Novak Gynecology Ch. 14) + CDC STI Treatment Guidelines 2021, updated 2024 (Workowski MMWR 2021 PMID 34292926) + Wechter 2009 Obstet Gynecol Surv PMID 19099613 + Word 1968 (PMID NEEDS_SOURCE_REVIEW) + Visco & Del Priore 1996 Obstet Gynecol PMID 8559513 + Heller & Bean 2014 J Low Genit Tract Dis PMID 24803013 + Kessous 2013 Obstet Gynecol PMID 23232761 + Tanaka 2005 J Clin Microbiol PMID 15634986 + Berger 2012 Obstet Gynecol PMID 22914407 + Pundir 2008 J Obstet Gynaecol PMID 18608239 + Marzano & Haefner 2004 J Low Genit Tract Dis PMID 15454803