Vol. 15 Issue 5
Bartholin Cyst Abscess
Bartholinitis is the inflammation of one or both of the Bartholin's glands at the opening of the vagina. Obstruction of the main duct of these glands causes retention of secretions and dilation of the gland. If the gland is swollen and painful, incision and drainage of abscessed Bartholin's glands are necessary. A culture of the abscess material should determine the etiology of the abscess.
Approximately 2% of women develop an abscess of the Bartholin's glands, and recurrence is common. The most common causes are shown in Table 1. Symptoms include swelling of the labia, tenderness or pain in the labia when walking or sitting, enlarged inguinal nodes, dyspareunia, and palpable mass.
Incision and drainage of a Bartholin's cyst abscess are done to relieve pain, determine the etiology and provide treatment guidance. The procedure is contraindicated in pregnancy. Equipment needs are outlined in Table 2.
Prior to performing the procedure, instruct the patient to empty her bladder. Position the patient in the lithotomy position, and cleanse the perineum with antiseptic skin cleanser. After opening the gauze, scalpel, needle and syringes onto a sterile field, put on sterile gloves.
Inject 5 mL to 10 mL of 1% to 2% lidocaine along the top of the abscessed Bartholin's gland using the 10-mL syringe with the 25-gauge needle.
Incise the cyst along the top. Make the incision deep enough and long enough to allow drainage. A longer incision is considered better than a smaller incision. Culture the drainage.
Insert a gloved finger into the vaginal orifice and apply gentle pressure toward the abscess to express the exudate.
After all exudate is expressed, inspect the wound with curved hemostats and break up any loculations (small cavities).
Irrigate with 0.9% sodium chloride using the 20-mL syringe with the 18-gauge needle. Insert iodoform gauze into the wound, leaving approximately 1 inch protruding from the wound. Cover with 4x4 gauze sponges and apply a perineal pad to absorb drainage.
Following the procedure, instruct the patient to remove half of the gauze in 24 hours and the remaining gauze in 48 hours. The perineal pad should be changed every 4 to 6 hours. Soaking in a basin or tub of warm water three to four times per day for 1 week will bring blood to the area and assist with healing. A follow-up office visit is necessary 1 week postprocedure, or sooner if complications occur. To prevent infection, prescribe antibiotics for 7 days: doxycycline 100 mg twice daily, erythromycin 500 mg three times daily, or cephalexin 500 mg three times daily.
Use the following current procedure terminology (CPT) billing codes:
56420 Incision and drainage of Bartholin's gland abscess
56740 Excision of Bartholin's gland or cyst.
Colyar MR, Ehrhardt C. Ambulatory Care Procedures for Primary Care Providers. Philadelphia, Pa.: F.A. Davis; 2003.
Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, Mo.: Mosby; 2003.
Youngkin EQ, Davis MS. Women's Health. A Primary Care Clinical Guide. Norwalk, Conn.: Appleton & Lange; 1998.
Margaret Colyar is a family and pediatric nurse practitioner who is codirector of the NP program at the University of Utah in Salt Lake City. She is an assistant professor and has a doctorate in nursing science.
Table 1: Common Causes of Bartholinitis
Congenital narrowing of the gland
Table 2: Equipment Needed
Antiseptic skin cleanser
1% to 2% lidocaine (5 mL to 10 mL)
Two syringes (10 mL and 20 mL)
Two needles (18-gauge and 25-gauge, 1- to 1-inch needle)
0.9% sodium chloride (250 mL)
No. 11 scalpel
4-inch by 4-inch gauze (sterile)
Lodoform gauze (- to -inch wide)
Curved hemostats (sterile)
Vaginal culture swab
Perineal pads (nonsterile)