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Patient Education
General: Wear loose clothing.
Activity: Avoid sexual activity, douching or tampons until wound healed. Limit physical activity for 48-72
hours.
Medications: Avoid doxycycline in pregnancy, breastfeeding and children. Avoid sun exposure with doxycy-
cline.
No Improvement/Deterioration: Return immediately for purulent or foul-smelling drainage, increased pain
over baseline discomfort, redness and persistent heat in the area.
Follow-up Actions
Wound Care: Sitz baths or warm compresses tid. Keep area clean and dry.
Return evaluation: 48 hours and two weeks post-op.
Evacuation/Consultation Criteria: Evacuate immediately for worsening pain or signs of expanding infection.
Evacuate if no improvement in 48 hours or if abscess recurs.
NOTES: If lab evaluation positive for gonorrhea or chlamydia, treat as in Pelvic Inflammatory Disease Section.
Women over age 40 with new-onset Bartholin’s cyst have a slightly increased risk of Bartholin’s gland cancer.
Biopsy is necessary.
Asymptomatic cysts in women under 40 may be observed. A gynecologic exam should be performed yearly.
Incision and Drainage of Bartholin’s Gland Abscess
When: When the Bartholin’s cyst becomes an abscess.
What You Need: Sterile prep and drape, local anesthetic agent such as 1% lidocaine (with or without
epinephrine), 5 cc syringe, 18 gauge needle to draw up the lidocaine, 22-26-gauge needle for injection, scalpel
with 15 or 11 blade, Kelly clamp or other instrument to insert into abscess and break up any loculations or
adhesions, Foley catheter (if available), suture with needle (if available).
What To Do:
- Discuss and describe procedure with the patient. Keep her informed as you move along.
- Give dose of antibiotics as above.
- Gather materials and set up surgical site
- Fill 5 cc syringe with lidocaine using 18-gauge needle; replace 18 gauge with smaller gauge needle for
injection. - Protect yourself – abscess may spray when opened and decompressed (mask, gloves, gown if you
have one). - Place patient in low lithotomy position (patient lies on her back with her buttocks at the end of the
table and her feet supported in stirrups). If table with stirrups not available then patient may lie on
table or bed with feet drawn up to buttocks and ankles together in midline. It may help to place a
pillow underneath the buttocks. - Apply sterile prep and drape
- Inject anesthesia (3-5 cc of lidocaine should be sufficient) in triangular pattern around abscess. Wait
5 minutes. - Test for numbness by pinching skin lightly with Adson forceps or other sharp object. Inject 2-3 cc more
anesthetic if necessary. - Identify incision site – inside the vaginal mucosa outside the hymenal ring near the usual duct opening
- Make a vertical incision in the vaginal mucosa approximately 1 cm long. It must enter the abscess cavity.
If pus is not draining out you are not there yet. Gradually deepen the incision until reaching the abscess. - Insert Kelly clamp into the abscess to a depth of 2-3 cm if possible, and break up any loculations or
adhesions. Allow the abscess to drain.