Bartholins abscesses occur when the Bartholins glands, located on either side of the opening of the vagina, become obstructed and infected. If the gland becomes blocked, a cyst will usually form first. If the cyst becomes infected, it can lead to a Bartholins abscess. The abscess can be more than an inch in size and cause extreme pain. While most Bartholins abscesses end with a full recovery, there is a 10 percent chance that the condition will come back.
Most experts believe that a Bartholins abscess begins with an obstruction of the opening of the gland. There are two Bartholins glands, each about the size of a pea, with one on each side of the vaginal opening. They provide lubrication to the vaginal membranes. Bacteria that get into the gland can cause an infection, swelling, and an obstruction. Fluid builds up in the gland, increasing pressure in the area. If the infection and swelling advance, the gland may abscess, breaking open the skin. Bartholins abscesses usually only appear on one side of the vagina at a time.
It may take years for fluid to build up enough to form a cyst, but an abscess will make itself known right away. A Bartholins abscess can be extremely painful and the area will likely be red, swollen, and fevered.
Doctors believe that bacteria such as E. coli, or sexually transmitted diseases (STDs) such as chlamydia or gonorrhea, may cause the infections that lead to Bartholins abscesses.
To determine if you have a Bartholins abscess, your doctor will perform a physical exam to check for any lumps or bumps within the vagina that would indicate an abscess. A fluid sample will likely be taken from the area to examine for any STDs present that may need treatment as well. If you are over the age of 40, or have already gone through menopause, your doctor may want to perform a biopsy on any masses found in the vagina to rule out other possible source of the problem.
It is possible to treat a Bartholins abscess at home with the use of sitz baths. In a sitz bath, you fill the tub with warm water only up to hip level. It may take many days of sitz baths to treat the abscess because the opening of the Bartholins gland is very small and it may close before drainage is complete. Though soaking may not be the most effective cure, a sitz bath can soothe your pain and discomfort. With a Bartholins abscess, you should soak in three or four sitz bath a day, for at least 10 to 15 minutes each.
If the abscess is very large, your doctor may decide it best to drain it surgically. This procedure can be performed in your doctors office under local anesthesia, but general anesthesia in a hospital is also an option. Talk to your doctor about the best course for you.
During the surgery, an incision is made in the abscess and a catheter is placed inside to drain the fluid. The catheter may remain in place for several weeks. Once the abscess has healed, the catheter can be removed by a surgeon or allowed to just fall out on its own.
Since the abscess is likely the result of an infection, your doctor may prescribe antibiotics. But in most cases antibiotics are not required if the abscess is properly drained.
If you continue to develop Bartholins abscesses and find they greatly impact your quality of life, your doctor may want to perform a procedure called a marsupialization. This is a surgery very similar to the other drainage procedure. However, instead of allowing the incision to close, your doctor will stitch the incision open to allow for maximum drainage. A catheter is typically still used. Marsupialization can be performed under local anesthesia, but depending on the size and complexity of the abscess, your doctor may perform the procedure under general anesthesia. Your doctor will treat any infection present before the surgery.
If none of these procedures are permanently successful, your doctor may recommend your Bartholins glands be removed. This surgery is rather rare and would require general anesthesia in a hospital setting.
If you have developed a painful, swollen lump near the opening of your vagina, call your doctor if it does not go away after a few days of warm sitz baths. If you develop a fever or the pain starts interfering with your daily activities, consult with your doctor for treatment. You should have no lasting effects from the abscess once it is successfully treated.