A Bartholin gland cyst is a swelling at the entrance of the vagina, usually painless; bartholinitis is the painful infection of that gland. A cyst without symptoms is monitored. An abscess is drained. If it recurs, marsupialisation or excision can be discussed. Dr Jérémie Zeitoun sees patients in the 8th arrondissement of Paris.
The Bartholin gland is a small gland sitting on either side of the vaginal entrance, embedded within the labia majora. In its normal state it measures about 1 cm and remains imperceptible: it drains through a fine duct into the vulvar vestibule, and contributes to natural lubrication.
Cyst and bartholinitis
Two very different situations can bring it to medical attention. The first is the cyst: the duct becomes blocked, the gland retains its secretions and forms a fluid-filled pouch.
The second is bartholinitis: the gland becomes acutely infected, producing a red, hot and extremely painful abscess. Two faces of the same anatomy, but with very different management.
This article explains how each of these situations is diagnosed and treated, which surgical techniques exist (emergency drainage with healing by secondary intention, marsupialisation, excision of the gland), and what to expect after surgery.
It draws on the CNGOF/SCGP 2024 guidelines and on recent studies (WoMan-trial 2017, Bakouei meta-analysis 2024, French trial NCT04093310).
A cyst that keeps coming back? Dr Zeitoun sees you in a cold setting to confirm the diagnosis and discuss surgery.
Understanding the Bartholin gland
Before discussing surgery, a few points to understand what this small gland is, why it can become a problem, and why the solutions differ depending on the situation.
Where are the Bartholin glands located?
The Bartholin glands — also known as the greater vestibular glands — are two small paired glands located posterolaterally, at approximately 4 o'clock and 8 o'clock with respect to the vaginal opening.
In their normal state they measure 0.5 to 1 cm, lie deep within the labia majora and are neither visible nor palpable. Their excretory duct, about 2.5 cm long, opens into the vulvar vestibule.
They secrete mucus that contributes to vulvar lubrication during intercourse, alongside other vulvo-vaginal glands.
A paired and discreet gland
The two Bartholin glands sit on either side of the vaginal entrance, deep within the labia majora, in a posterolateral position. They measure about 1 cm at rest and cannot be felt on examination.
A role in lubrication
These glands contribute to natural lubrication of the vulva and vagina, particularly during intercourse. Their contribution is modest — other mechanisms also provide lubrication — which is why unilateral excision generally has no perceptible impact.
Two distinct conditions
When the duct becomes blocked, the gland forms a cyst. When it becomes infected, it is bartholinitis: a very painful abscess. The two situations require different treatments.
👉 A painless lump that does not change is most likely a cyst. Sudden pain with redness, warmth and the inability to sit is bartholinitis — a situation that should not wait.
Recognising a cyst and bartholinitis
The diagnosis is essentially clinical: visual inspection and palpation are enough in the vast majority of cases.
The cyst
A rounded, soft swelling at the vaginal entrance, on one labium majus. Often painless, sometimes discovered by chance. It may remain stable for months or years, then become troublesome: tugging when walking, discomfort when sitting, superficial dyspareunia, discomfort wearing tight underwear.
The abscess (bartholinitis)
Sudden onset over 24 to 48 hours. The swelling becomes red, hot and very painful, sometimes with fever. Walking is difficult, sitting impossible. This is a relative emergency: drainage provides rapid relief.
The recurrent cyst
Some patients alternate between cyst and bartholinitis episodes. In this pattern, a definitive surgical solution is usually preferable to repeated drainages, which exhaust the patient and create scar tissue.
What it can resemble
Not every vulvar lump is a Bartholin cyst: epidermoid cyst, sebaceous cyst, hidradenoma, lipoma, canal of Nuck cyst… Clinical examination distinguishes most cases. Histological analysis is performed routinely after excision.
Why a Bartholin cyst causes such discomfort when sitting
The gland sits deep within the labium majus, in a posterior position. As it enlarges, the pressure exerted by the seat or by tight clothing bears directly on the affected area.
This is why many patients first describe a very specific discomfort while sitting for long periods, at the wheel, at the office, or during sport.
This symptom should raise suspicion of a Bartholin gland condition and prompt a consultation.
When does surgery become useful?
All Bartholin cysts do not need surgery — far from it. Here are the situations where a procedure is indicated.
A cyst that interferes with daily life
When the cyst becomes painful, hampers walking, sitting or sexual intercourse, or is large enough to cause real discomfort. The aim of surgery is to relieve symptoms and prevent recurrence.
An acute bartholinitis
When an abscess forms, drainage is urgent to relieve pain and prevent complications. The procedure is short, very efficient, and the relief immediate.
Repeated bartholinitis episodes
If you have already had several abscesses or your cyst keeps returning after drainage, a definitive surgical solution should be discussed: marsupialisation or, more often, complete excision of the gland.
Vigilance after age 40
In a woman over 40 or postmenopausal, any new Bartholin swelling warrants particular attention. The ACOG and UpToDate (September 2024 update) recommend systematic biopsy or histological analysis after excision, since carcinoma of the Bartholin gland — though rare — exists.
When should you consult quickly?
If you notice a painful, hot, red lump that came up over a few hours or days, especially with fever or difficulty walking, do not wait: that is bartholinitis. Seek prompt medical assessment to organise drainage.
If you have a lump that has been present for a long time, soft and painless, but which is starting to bother you, schedule a cold consultation to discuss the appropriate management.
Which procedure for your situation?
Surgery does not follow the same logic depending on whether you have an acute abscess (bartholinitis) or a recurrent cyst. Here is how I approach each of these two situations.
A simple drainage, nothing more.
When facing a hot, painful abscess, the only goal is to relieve you quickly. We open, drain, and let it heal. I never perform marsupialisation in the emergency setting: on inflamed, infected tissue, it is neither the right moment nor the right technique.
Local or operating theatre
Depending on context (size, pain, accessibility), drainage can be done under local anaesthesia in the consulting room, or in theatre under general or regional anaesthesia for greater comfort.
5 minutes in theatre
A small incision at the vaginal entrance, the pus is drained, the cavity rinsed. No sutures. The procedure takes about 5 minutes. Almost immediate relief upon waking.
Everything is left open
The incision is left to heal flat, from the inside outwards. This is known as healing by secondary intention. The opening closes spontaneously over a few weeks.
This drainage relieves the acute episode. It does not address the underlying problem: if the gland keeps blocking, a new episode may occur. That is why, after recovery, I review the patient at a later stage to discuss next steps.
This is where real, planned management takes place.
When the cyst is visible and palpable away from any infection, or when you have already had several bartholinitis episodes, we calmly plan a procedure to treat the underlying problem. Two main options.
Marsupialisation
Under general anaesthesia, the cyst is opened and its edges are sutured to the skin to create a permanent opening. The gland keeps functioning. In practice, I more often propose excision, which is more durable, but marsupialisation remains a valid option in certain situations.
Excision of the Bartholin gland
Under general anaesthesia, the gland is removed entirely. The cavity is closed with internal sutures. This is the procedure I propose most often, because it is definitive: no gland, no recurrence. The gland on the other side maintains lubrication.
Which anaesthesia? For marsupialisation or cold excision, I favour general anaesthesia in theatre.
In certain specific cases (small size, contraindication to general anaesthesia, highly motivated patient), local or regional anaesthesia (spinal, epidural) may be considered — with a clear warning: the procedure remains painful and a conversion to general anaesthesia may be required during the operation.
The decision is taken jointly with the anaesthetist.
What is the Word catheter, exactly? Picture a small silicone catheter, around 5 cm long, with an inflatable balloon at its tip.
The technique: a mini-incision is made into the cyst (4–5 mm) under local anaesthesia, the catheter is inserted into the cyst cavity, then the balloon is inflated with a small amount of saline so it stays in place.
The catheter is left in for 2 to 4 weeks: during this time, prolonged contact between skin and cyst cavity creates a permanent new drainage tract (epithelialisation). The catheter is then removed, and the gland drains naturally through this new opening.
The Word catheter is widely used abroad (Netherlands, United Kingdom, United States), often in the consulting room. In France, its uptake remains limited — a French multicentre trial (NCT04093310) is currently evaluating its cost-effectiveness in 17 centres including Caen University Hospital.
I do not offer it routinely: I favour marsupialisation or excision in theatre, which feel better suited to French practice and to patient comfort.
Monitor, marsupialise or remove: Dr Zeitoun chooses the right technique with you, at the Paris 8th practice or Clinique Hartmann.
What the recent literature tells us
Bartholin gland surgery has been the subject of several major publications and ongoing clinical trials. Here is an overview of the current data.
Word catheter or marsupialisation?
The multicentre randomised WoMan-trial (Kroese et al., BJOG 2017, DOI 10.1111/1471-0528.14375) compared the Word catheter with marsupialisation in 161 patients. Recurrence rates at one year were comparable. A 2024 meta-analysis (Bakouei et al., JOGC) including 735 patients confirmed the absence of any significant difference.
👉 In French practice: uptake remains limited, and marsupialisation or excision in theatre remain the reference procedures for the great majority of patients.
Which technique is best?
The systematic review by Illingworth et al. (BJOG 2020) evaluated all available techniques. Conclusion: no technique has demonstrated absolute superiority. The choice depends on the clinical context and patient preference.
Outpatient models tested abroad
The Irish study (Worrall et al., IJGO 2025, DOI 10.1002/ijgo.15850) involving 408 patients evaluated an in-office Word catheter programme. The authors report organisational gains. In my own practice in France, I favour general anaesthesia in the operating theatre: patient comfort, precise surgical gesture, careful internal suture.
An ongoing French multicentre trial
The French health-economic study NCT04093310 compares the Word catheter with incision-drainage across 17 centres including the university hospitals of Caen, Bordeaux, Angers, Clermont-Ferrand and the Franco-British Institute. Cost-utility evaluation.
Surveillance after menopause
According to ACOG and UpToDate (September 2024 update), any Bartholin gland swelling in a woman over 40 or postmenopausal deserves particular attention.
Bartholin gland carcinoma remains rare (≈5% of vulvar cancers) but may be mistaken for a benign cyst. In my practice, every excised specimen is sent for histology — without exception.
⚠️ Important recommendation: according to ACOG and UpToDate (September 2024 update), any Bartholin gland swelling in a woman over 40 or postmenopausal deserves particular attention, with routine biopsy or histological analysis after excision.
Carcinoma of the Bartholin gland is rare (≈5% of vulvar cancers) but may be mistaken for a benign cyst. In our practice, every excised specimen is sent for histology — without exception.
What recovery looks like
Whether after a drainage, a marsupialisation or an excision, the post-operative course is fairly similar and generally straightforward. Here is what to expect.
The day of surgery
Arrival in theatre in the morning, fasting. A short procedure. Same-day discharge in the vast majority of cases. An ice pack may be used during the first few hours.
The first few days
Moderate pain relieved by simple painkillers. Gentle vulvar hygiene, drying by patting. Showers from the next day, baths avoided until healed. Some patients use a doughnut cushion to sit.
The second week
Pain fades. Sick leave 10 to 15 days. A "lump" may be felt on palpation, related to the internal suture: this is not a recurrence, it eases as the absorbable sutures dissolve. No stitches to remove.
Post-operative visit
Healing check at 3 to 4 weeks. At this point, resumption of physical and sexual activity is approved. Gentle local massage and a lubricant help to resume comfortably.
Full recovery
By two months, healing is usually complete and the area becomes barely noticeable. The scar is internal and therefore invisible.
When to seek advice again
If you experience: fever, intense pain unrelieved by painkillers, purulent or foul-smelling discharge, heavy bleeding. A call to the secretary is enough to be directed.
No lasting problem expected
If a Bartholin gland is removed, will I have lubrication problems? Usually not. The contralateral gland, intact, takes over. If lubrication seems reduced — often only transiently — using an intimate lubricant during intercourse is generally enough.
No lasting impact is expected after unilateral excision.
A few words on the surgical background
Expertise in benign and oncological gynaecological surgery
Dr Jérémie Zeitoun holds a French specialist degree (DES) in obstetrics and gynaecology and a subspecialty diploma (DESC) in gynaecological surgical oncology.
Trained at Centre François Baclesse, Institut Curie and Institut Gustave Roussy, he manages the full range of vulvar and vaginal conditions — from Bartholin cysts to more complex lesions — at the Paris 8th practice and at the Hartmann Clinic in Neuilly-sur-Seine.
Discover the background →Frequently asked questions
I have a very painful abscess right now — what should I do?
In the case of acute, very painful bartholinitis, drainage should be performed quickly. Drainage is a short, standard procedure, performed under local or general anaesthesia. Once the acute episode has resolved, I am available to review you in a cold setting and to discuss next steps.
How long does the emergency drainage take?
The procedure itself is very short — about 5 minutes in theatre. Under local or general anaesthesia depending on context, a small incision is made, the pus is drained and the cavity rinsed. No sutures are placed. Relief is almost immediate. You go home the same day.
What exactly is "healing by secondary intention"?
After drainage of an abscess, the skin is not sutured: the incision is left open. This is known as healing by secondary intention (also referred to as "directed healing"). Healing occurs from the inside outwards, naturally, over several weeks. This is the reference method for tissue that has been infected: closing too early would risk trapping the infection.
What is the difference between a Bartholin cyst and bartholinitis?
The cyst is a non-infected obstruction of the gland's duct, forming a fluid-filled pouch that is often painless. Bartholinitis is the acute infection of the same gland, producing a red, hot, very painful abscess. Their management is completely different.
Should a painless Bartholin cyst be operated on?
No. An asymptomatic, stable cyst that does not interfere with daily life requires no surgery. Self-monitoring is sufficient, with consultation if any change occurs.
Is needle aspiration in the consulting room as good as surgery?
A simple needle aspiration in the consulting room provides brief relief, but it is poorly effective and the recurrence rate is high. By contrast, surgical drainage by incision — whether under local anaesthesia or in theatre — is the reference management in emergencies. The procedure is short (about 5 minutes in theatre), the area is left to heal flat, and the opening closes spontaneously over a few weeks.
Can I have my procedure under local or regional anaesthesia?
In certain specific cases (small well-localised cyst, contraindication to general anaesthesia, highly motivated patient), marsupialisation or excision may be performed under local or regional anaesthesia (spinal, epidural). To be clear: the risk of intra-operative pain is real, and a conversion to general anaesthesia may be required during the procedure. The decision is made jointly with the anaesthetist.
Marsupialisation or excision — which will I be offered?
In my practice, I more often propose complete excision of the gland than marsupialisation. Why? Excision is definitive — the gland no longer exists, the risk of recurrence disappears — and the gland on the other side maintains lubrication very well. Marsupialisation remains a valid option, particularly when sparing the gland is a priority, but it carries a risk of recurrence if the new opening closes.
How long is the sick leave?
Usually 10 to 15 days, depending on your activity. Sitting and prolonged walking may remain uncomfortable during the first fortnight. Some patients use a doughnut cushion to sit.
When can I resume sexual intercourse?
Usually after the 3–4 week follow-up visit, once healing has been confirmed. The area may remain sensitive for a few weeks: gentle local massage and the use of an intimate lubricant can be helpful at the start.
Will I have lubrication problems after excision?
Usually not. The contralateral gland, left in place, takes over and largely compensates for the lubrication function. No lasting impact is expected after unilateral excision.
Is the surgery reimbursed?
Yes. Bartholin gland surgery is a medically justified procedure, covered by the French national health insurance. I charge supplementary fees, which are explained transparently during consultation and formalised in a written estimate provided before surgery. Depending on your private insurance, some or all of these fees may be reimbursed.
What is the Word catheter?
The Word catheter is a small silicone balloon catheter, inserted into the cyst or abscess through a mini-incision under local anaesthesia. It is left in place for 2 to 4 weeks to create a permanent drainage tract. Studies (WoMan-trial 2017, JOGC 2024 meta-analysis) show recurrence rates comparable to marsupialisation. In France, its uptake remains limited.
I am postmenopausal. Should I worry about cancer?
Carcinoma of the Bartholin gland is rare (≈5% of vulvar cancers) but may present as a cyst or an abscess. ACOG and UpToDate (2024) recommend particular vigilance in women over 40 or postmenopausal, with systematic histological analysis after excision. In our practice, every surgical specimen is sent for histology, without exception.
Should I stop smoking before surgery?
Yes, this is strongly recommended. Tobacco impairs healing quality. Stopping for at least 4 to 6 weeks before and after surgery significantly improves the post-operative course.
Several episodes of bartholinitis? Dr Zeitoun sees you in a cold setting in Paris 8th or at Clinique Hartmann, Neuilly.