Marsupialisation of a Bartholin (vestibular) gland cyst

A Bartholin gland cyst or abscess may end up being marsupialised, which means that instead of removing or draining the cyst, it is opened up and sewn to the surrounding tissue, where it remains open and can drain freely without causing damage or discomfort.

The name comes from the result being like a pouch. This surgical procedure involves many intricate considerations, like blood and nerve supply to the glands themselves, and to surrounding tissues.

When is marsupialisation suitable for a Bartholin gland cyst or abscess?

If you have a history of Bartholin gland cysts or abscesses, are in a great deal of pain or discomfort, or the cyst doesn’t resolve itself in good time or with other treatments, marsupialisation may be recommended.

This treatment can be done on almost anyone who agrees to it.

Surgery considerations

It must be determined whether it is a cyst or an abscess, if infection is present, is it malignant, and if the person is able to heal adequately.

The surgery

The surgery is done under local anaesthetic or a combination of sedation and local anaesthetic. Bleeding is usually minimal for this quick procedure, where you’ll be put on your back with your feet in stirrups for easy access.

Once you are anaesthetised appropriately, the surgeon will examine you to check the nature of the cyst or abscess, then the bladder will be drained using a catheter.

Your labia will be pulled back so the surgeon can see what he or she is doing clearly. The cyst is cut and drained, with cultures sent to the lab to be tested. Then, the walls of the cyst are sutured (sewn) to the nearby area. That’s it.

What to expect after the operation

You will probably be advised to take hot sitz baths after 1-2 days post-operatively, and be given pain medicine (ibuprofen, paracetamol/acetaminophen or other narcotic for severe pain).

Antibiotics are usually not prescribed automatically unless there is evidence to suggest they would be necessary, although you may be taking antibiotics for abscesses.

You can start having sex again four weeks after surgery so long as everything has healed properly. Recurrence rates are high for some women, but range from 2-25 per cent, even with surgery.

Infection is also a risk, since the vagina and anus are so close to each other, so excellent hygiene is critical. You may end up with unresolved, undiagnosable pain from the surgery. This may result in dyspareunia, and may be due to nerve damage or scarring.

This sort of pain is terrible, ongoing, and unresolvable, so it is important to find a reputable, experienced surgeon (in this particular operation). Numbness is possible in the labia, or you may find extra vaginal discharge. Talk these symptoms over with your surgeon or doctor.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)