Uncertain Diagnosis

If the diagnosis of Bartholin’s duct cyst or abscess is unclear or if there is suspicion of malignancy (see differential diagnosis above) then consultation with a specialist is advised and consideration for biopsy or excision of vulvar or vaginal mass should be performed. 7

Recurrent Duct Cyst or Abscess

A patient with a recurrent Bartholin’s duct cyst that previously failed adequate Word catheter placement (i.e. 4-6 week trial) should be offered marsupialization. A second trial of Word catheter treatment can also be considered if the patient wants to avoid an operating room procedure.

Inability to tolerate procedure

If the patient is unable to assume the dorsal lithotomy position and tolerate an I&D type procedure under local anesthesia, alternative techniques (such as general anesthesia) should be considered.

Asymptomatic and small cysts

Asymptomatic Bartholin’s duct cysts should generally be managed expectantly, unless there is a concern for malignancy. 5,7,22

Bartholin’s duct cysts that are smaller than the Word catheter balloon or cysts/abscesses that are too deep are not amenable to Word catheter placement. 17

anticoagulation

Anticoagulation therapy with warfarin or aspirin is not considered a contraindication to Word catheter placement for symptomatic Bartholin’s duct cyst or abscess. Multiple studies have shown no increased risk of hemorrhagic complications in patients undergoing cutaneous surgery while taking warfarin or aspirin compared to controls. 16 Given that life-threatening thromboembolic complications have been related temporally to perioperative discontinuation of both aspirin and warfarin, continuation of these medications is recommended in most cases. 9,16 It is recommended to confirm that the INR does not exceed the therapeutic range in patients taking warfarin and take the individual’s medical history and risk factors into account when making this clinical decision.