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Bartholin's cysts and abscesses, Word catheter, marsupialisation and gland excision.

A cyst is a blocked duct. An abscess is an infected one. The right treatment depends on which you have, how often it recurs, and your age.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against RCOG, BASHH and peer-reviewed gynaecology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including Word catheter, marsupialisation, CO2 laser and sclerotherapy.

Key facts

Bartholin's cysts and abscesses at a glance.

The essentials in plain English - the difference between the two, who they affect, and how they are managed in the UK today.

  • What it is

    A Bartholin cyst forms when the duct of the greater vestibular gland blocks. An abscess is a secondarily infected cyst, painful and fluctuant.

  • Cyst vs abscess

    A cyst is often painless, slow-growing and holds mucoid fluid. An abscess is acute, erythematous, tender and frequently polymicrobial.

  • Who it affects

    Most common in women of reproductive age. A new cyst or mass over 40 years always warrants biopsy to exclude carcinoma.

  • First-line care

    Small painless cysts often need only sitz baths and observation. Symptomatic disease or an abscess needs drainage with a Word catheter.

  • Recurrence

    Simple incision alone recurs commonly. Marsupialisation or gland excision is used for recurrent disease.

  • Red flag

    Any solid, fixed or atypical mass, or a Bartholin swelling after 40, needs urgent gynaecology review and biopsy.

Why this guide matters

The right procedure the first time.

Simple incision alone recurs commonly. Choosing the right procedure early - and biopsying anything atypical - matters.

  • Distinguish cyst from abscess

    A painless mucoid cyst and a hot fluctuant abscess look similar to a patient but need very different management.

  • Choose a durable procedure

    Word catheter, marsupialisation, CO2 laser and sclerotherapy all have a lower recurrence rate than simple incision.

  • Never miss a carcinoma

    Any new Bartholin mass over 40, or an atypical lesion at any age, must be biopsied to exclude gland carcinoma.

How the diagnosis is made

From first swelling to a clear plan.

The steps a UK GP or gynaecologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and pain pattern

    How long the swelling has been present, pain, fever, dyspareunia, walking discomfort and any previous episodes.

  2. 02

    Assessing

    Focused vulval examination

    Unilateral posteroinferior labial swelling, fluctuance, erythema, temperature and lymphadenopathy are all assessed.

  3. 03

    Assessing

    Cyst versus abscess

    A soft, painless mass suggests a cyst. Acute pain, erythema and fluctuance point to an abscess.

  4. 04

    Confirming

    Swab if drained

    Pus is sent for culture and sensitivity, with attention to E. coli, staphylococci and anaerobes.

  5. 05

    Confirming

    STI screen

    Full BASHH screen for chlamydia, gonorrhoea, trichomonas and Mycoplasma genitalium in every abscess.

  6. 06

    Preparing

    Biopsy over 40

    Any new Bartholin mass in a woman over 40, or an atypical or persistent lesion, needs biopsy to exclude carcinoma.

  7. 07

    Preparing

    Plan the procedure

    Choose Word catheter, marsupialisation, CO2 laser, silver nitrate, sclerotherapy or gland excision based on recurrence and preference.

Typical timeline: first visit to procedure within days for an abscess, and weeks for a cyst.

Symptoms

What a cyst or abscess actually feels like.

The classic pattern of unilateral labial swelling, the differences between cyst and abscess, and the features that mean it is time to be seen urgently.

  • Cyst - painless labial swelling

    Unilateral swelling at the four or eight o clock position of the introitus, often noticed by chance.

  • Cyst - dyspareunia or walking pain

    Large cysts can cause pressure, dyspareunia, a heavy sensation and discomfort when sitting or cycling.

  • Abscess - acute severe pain

    Rapid onset throbbing pain within days, hot to touch, erythematous and often fluctuant on gentle palpation.

  • Abscess - purulent drainage

    Spontaneous rupture releases pus and gives sudden relief but the abscess typically reforms without proper drainage.

  • Systemic features

    Fever, malaise, tachycardia and surrounding cellulitis in more severe or neglected abscesses.

  • Recurrent or chronic disease

    Repeated episodes suggest a persistently narrow duct opening or scarring and often lead to definitive surgery.

  • Postmenopausal mass

    A new Bartholin swelling after the menopause is uncommon and must be biopsied to exclude gland carcinoma.

  • Red flag - sepsis

    Spreading cellulitis, high fever, rigors or hypotension needs urgent hospital assessment and IV antibiotics.

Treatment

How Bartholin's disease is treated in the UK.

Conservative care for a small painless cyst, Word catheter or marsupialisation for most abscesses, and gland excision for troublesome recurrence.

  • Sitz baths and NSAIDs

    Warm sitz baths several times a day plus simple analgesia can settle small cysts and help a pointing abscess to drain.

  • Targeted antibiotics

    Reserved for cellulitis, systemic features or high-risk patients. Co-amoxiclav, or doxycycline plus metronidazole if penicillin-allergic.

  • Word catheter insertion

    An office procedure under local anaesthetic. A small balloon catheter is left in place for four to six weeks to form a new duct.

  • Incision and drainage

    Rapid relief for a painful abscess but recurrence is high if left as a simple stab incision without a catheter or marsupialisation.

  • Marsupialisation

    Surgical creation of a new permanent duct opening by suturing the cyst wall to the vestibular skin. Lower recurrence than I and D alone.

  • Needle aspiration

    Quick and simple but recurrence rates are high, so it is generally used as a temporising measure only.

  • CO2 laser fenestration

    Ablation and fenestration of the cyst wall under local anaesthetic. Increasingly used with good short and medium-term results.

  • Silver nitrate insertion

    A small silver nitrate stick is placed in the cavity after drainage to promote sclerosis of the cyst wall.

  • Alcohol sclerotherapy

    Instillation of 70 percent ethanol into the drained cyst cavity. Emerging evidence suggests useful recurrence reduction.

  • Gland excision (Bartholinectomy)

    Definitive treatment for troublesome recurrent disease. Higher morbidity including haematoma, dyspareunia and wound problems.

  • Biopsy in women over 40

    Mandatory for any new Bartholin mass over 40 to exclude adenocarcinoma, squamous cell carcinoma and other rare tumours.

  • STI screen and safe sex advice

    Full BASHH screen with treatment of any co-existing chlamydia, gonorrhoea or trichomonas, plus partner notification.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynaecologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • RCOG. Green-top guidance on vulval disorders and Bartholin gland pathology.

  • BASHH. UK national guidelines on the management of sexually transmitted infections.

  • NICE CKS. Bartholin cyst and abscess - assessment and management.

  • BJOG and Cochrane reviews on Word catheter, marsupialisation, CO2 laser and sclerotherapy.

Red flags

When Bartholin's disease needs urgent attention.

Most cases settle with straightforward treatment. These are the situations that need same-day or specialist review.

  • Systemic sepsis

    Rigors, high fever, tachycardia or hypotension with a Bartholin abscess needs urgent hospital assessment and IV antibiotics.

  • Spreading cellulitis

    Erythema extending well beyond the gland, or necrotic-looking skin, needs same-day gynaecology review.

  • New mass over 40 years

    Any new Bartholin swelling after 40 must be biopsied to exclude adenocarcinoma or squamous cell carcinoma.

  • Postmenopausal Bartholin swelling

    True Bartholin cysts are uncommon after the menopause. A biopsy is required to characterise any mass.

  • Fixed or firm mass

    A solid, irregular or fixed lesion, or one that fails to resolve after drainage, needs urgent gynae-oncology review.

  • Recurrent abscesses

    Two or more episodes usually warrant definitive treatment - marsupialisation, laser fenestration or gland excision.

  • Immunosuppression or diabetes

    A lower threshold for antibiotics and hospital review in patients with diabetes or immunosuppression.

  • Pregnancy

    Bartholin abscess in pregnancy needs careful antibiotic choice and shared care with obstetrics for drainage.

  • Concurrent STI

    A positive chlamydia, gonorrhoea or trichomonas test needs proper treatment and partner notification via GUM services.

Living with it

A treatable problem, with a clear pathway.

Four things that make the biggest difference after a procedure - simple wound care, sensible abstinence, a proper follow up and knowing when to escalate.

A quiet reminder

Recurrence deserves a rethink, not another simple drainage.

If you have already had one episode, the second visit is the right time to plan a durable procedure, not repeat the same one.

  1. 01 Aftercare

    Look after the wound

    Keep the area clean and dry, avoid tight underwear, and use warm sitz baths daily for a week or two after drainage.

  2. 02 Sex

    Abstinence for two to four weeks

    Avoid sexual intercourse and tampons while a Word catheter is in place and until any wound is fully healed.

  3. 03 Review

    Book the follow up

    A short follow up appointment confirms healing, allows catheter removal and picks up early signs of recurrence.

  4. 04 Escalate

    When to ask for more

    A second episode, an atypical mass or persistent pain deserves a proper vulval clinic opinion, not another simple drainage.

Frequently asked

Everything we get asked about Bartholin's cysts and abscesses.

Quick answers on cyst versus abscess, Word catheter, marsupialisation and when biopsy is essential.

  • What is the difference between a Bartholin cyst and a Bartholin abscess?

    A cyst is a blocked, non-infected Bartholin duct that fills with mucoid fluid. It is often painless and slow-growing. An abscess is a secondarily infected cyst - it is acutely painful, hot, red, fluctuant and frequently polymicrobial, with organisms such as E. coli, staphylococci, anaerobes and sometimes gonorrhoea or chlamydia.

  • Do all Bartholin cysts need treatment?

    No. Small, painless cysts in younger women can be observed with sitz baths and reassurance. Treatment is indicated for symptomatic cysts, an abscess, recurrent episodes, or any suspicious or persistent mass, particularly in women over 40.

  • What is a Word catheter and how does it work?

    A Word catheter is a short balloon catheter placed into the drained cyst or abscess under local anaesthetic. It is left in place for four to six weeks to form a new epithelialised duct opening, reducing the chance of recurrence compared with simple incision and drainage.

  • When is marsupialisation used?

    Marsupialisation is a short operation that creates a new permanent duct opening by suturing the cyst wall to the surrounding vestibular skin. It is often chosen for recurrent disease, larger cysts, or when a Word catheter has failed or is not tolerated.

  • Why is a biopsy so important in women over 40?

    Bartholin gland carcinoma is rare but important. Any new Bartholin mass in a woman over 40, or an atypical lesion at any age, needs biopsy to exclude adenocarcinoma, squamous cell carcinoma and other rare tumours before assuming a benign cyst.

  • What are my options if the abscess keeps coming back?

    Options include marsupialisation, CO2 laser fenestration, silver nitrate insertion, alcohol sclerotherapy and, for troublesome recurrent disease, gland excision (Bartholinectomy). Excision is definitive but carries a higher risk of bleeding, haematoma and dyspareunia.

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