Asymptomatic Bartholin’s duct cysts are generally observed without intervention. Women more than 40 years of age should be referred for consideration of gland biopsy or excision due to concern for rare malignancy. 5,7,15,20,22 Symptomatic Bartholin’s duct cysts and abscesses require intervention. Management options for symptomatic Bartholin’s duct cysts and abscesses include sitz baths (for cysts and abscesses that point or rupture spontanteously), I&D alone (not recommended due to high rate of recurrence) 8,17,20, Word Catheter placement, marsupialization (not for abscesses), placement of silver nitrate 12,13,25, and excision of gland & duct. 5,7,15,20,22
The subject of this chapter is Word catheter placement that can be easily accomplished as an ambulatory procedure. 2 This procedure is equally efficacious for Bartholin’s duct cysts as marsupialization, which typically is performed in the operating room, and is the preferred treatment for Bartholin’s gland abscess. 6,22 Word catheter serves as initial and long-term treatment and may avert the need for marsupialization. 18 Simple incision and drainage of a Bartholin’s duct cyst or abscess, as mentioned above, is complicated by a high rate of recurrence and is not recommended. 7,15,17,20
Placement of a Word Catheter was initially described by Buford Word MD in 1964. 24 He devised a single-barreled, sealed-stopper, inflatable balloon-tipped catheter to be placed inside a Bartholin’s duct cyst or gland abscess thereby draining its contents. The stem of this rubber catheter is one inch long and the diameter of a no.10 French Foley catheter. The small inflatable balloon tip of the Word catheter can hold about 3cc of saline. The successful use of this catheter is based on the principle that a foreign body in a wound that prevent closure results in formation of an epithelialized fistula or sinus tract. 24The small catheter is inserted through a small stab incision into the duct cyst or abscess after infiltration of the skin with local anesthesia. The balloon catheter is then inflated with 2-3 cc of saline and catheter remains in place for 4-6 weeks allowing epithelialization of a tract and the creation of a permanent gland opening. 2,5,24
Bartholin’s duct cysts and abscesses are common in reproductive age women. Two percent of women will experience a Bartholin’s duct cyst or gland abscess at some point in their lifetime. Eighty-five percent of Bartholin’s gland enlargement will occur during the reproductive years (age less than 40). 6,7, 15, 20 Bartholin’s duct cysts average 1-3 cm and are usually asymptomatic. Larger cysts are associated with vulvar pain, dyspareunia, and difficulty sitting or walking. Abscesses are characterized as painful, sometimes large, erythematous, edematous, fluctuant masses in the labia or lower vestibule. 7, 15 A Bartholin’s duct cyst is not necessarily a prerequisite to abscess formation. 22