Marsupialisation for Bartholin’s Cyst or Abscess

The Bartholin’s glands are two small glands located on either side of the vaginal opening. They produce a small amount of fluid to keep the vaginal area moist. If the duct (tiny tube) from one of these glands becomes blocked, fluid builds up and forms a painless swelling called a Bartholin’s cyst.

If this cyst becomes infected, it fills with pus and becomes very painful, red, and swollen. This is called a Bartholin’s abscess.

Marsupialisation is a minor surgical procedure to drain a persistent cyst or abscess and create a permanent new opening to prevent it from coming back.

Preparing for the Procedure

Pre-operative Assessment

• Your gynaecologist will examine the swelling to confirm it is a Bartholin’s cyst or abscess.
• They will discuss the procedure, its benefits, and alternatives (like simple incision & drainage or word catheter insertion).

Before the Procedure

• Medication: You can usually take your regular medications. Inform your doctor if you are on blood thinners.
• Anaesthesia: The procedure is usually done under local anaesthesia (numbing the area) with or without sedation, or sometimes under a short general anaesthetic.
• Fasting: If having sedation or general anaesthesia, you will be asked to fast (no food or drink) for about 6 hours beforehand.
• Support: As you may feel sore afterwards, arrange for someone to drive you home.

During the Procedure

• Setting: Usually performed as a day-case procedure in an operating theatre or a well-equipped clinic room.
• Duration: The procedure itself takes about 20 to 30 minutes.
• Steps:
  1. Anaesthesia is given.
  2. A small, oval-shaped piece of skin is removed from the cyst or abscess.
  3. The cyst is drained of fluid or pus.
  4. The edges of the cyst lining are then stitched to the edges of your skin (vulval skin) with dissolvable stitches. This creates a permanent, small opening (like a pouch or “marsupium”) that allows the gland to drain freely in the future.
• After the Procedure: You will be monitored in recovery for a short time before going home. A small gauze pad may be placed over the area.

First 24-48 Hours:

• Pain: You will have some soreness, which can be managed with over-the-counter painkillers like paracetamol or ibuprofen (if suitable for you).
• Swelling/Bruising: Mild swelling and bruising around the area is normal.
• Bleeding/Discharge: Expect some light bleeding or yellowish discharge for a few days. Use sanitary pads, not tampons.

• Keep wound Clean: Bathe or shower daily. Gently clean the area with warm water and pat dry.
• Sitz Baths: Starting 24 hours after surgery, sit in a warm, shallow bath (sitz bath) for 10-15 minutes, 2-3 times a day for 3-5 days. This promotes drainage, keeps the new opening clean, and soothes discomfort.
• Loose Clothing: Wear loose, cotton underwear and loose-fitting trousers or skirts to avoid friction.

Activity & Returning to Normal

• You can return to most normal activities within 1-2 days, but avoid strenuous exercise, cycling, or heavy lifting for 1-2 weeks.
• You can usually drive after 24 hours, once you feel comfortable and are not taking strong pain medication.
• Avoid sexual intercourse until the area is completely healed and comfortable, typically for at least 4-6 weeks.

Long-Term Outlook

• Healing: The dissolvable stitches will fall out on their own in 2-4 weeks. The new opening will gradually become smaller but should remain patent to allow drainage.
• Success Rate: Marsupialisation is very effective, with a low recurrencerate (around 10-15%) compared to simple drainage (which has a ~50% recurrence rate).
• Follow-up: You may have a follow-up appointment in the clinic to check healing, but often this is not needed if you recover well.

Frequently Asked Questions (FAQs)

Q: Is this a major operation?
A: No. It is a minor surgical procedure, often done under local anaesthetic. Most women go home the same day.

Q: What is the difference between this and a “Word Catheter”?
A: A Word catheter is a small balloon-tipped tube inserted into the cyst to drain it and is left in place for 4-6 weeks to form a tract. Marsupialisation is a more definitive surgical procedure that creates a permanent new opening and is often recommended for cysts or abscesses that keep coming back.

Q: Will this affect my sex life or sensation?
A: The goal is to relieve pain and prevent future problems. Once fully healed, it should not negatively affect sexual function or sensation. The area may be temporarily tender.

Q: Can I prevent Bartholin’s cysts?
A: There is no guaranteed way to prevent them, as blockage can occur spontaneously. Good genital hygiene and using condoms may reduce the risk of infection-related abscesses.

eGynaecologist Advice

• You should seek gynaecological consultation if you develop Increasing pain, redness, swelling, or foul-smelling discharge (signs of infection) or report heavy bleeding after the procedure.

You should seek early gynaecological review if the cyst or abscess returns after you have fully healed.