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What is the treatment for bartholin cyst that is large?

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Practicing since : 2002
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Im 28 y/o, i had a bartholin cyst since i was 27, before i had sexual intercourse. I was evaluated by a GYN and she gave me a Fluroquinolones that did not work. after 4 months married the cyst became larger, i went to an OBGYN he placed a needle and got a sample of the fluid, which was not an abcess but normal. Secretion culture came + for Klebsiella pneumonia. he 1st started tx w/ cipro for 5days which did not worked, then w 1st gen cephalosporins for 7days, cyst is the same. I went back to the OBGYN & he told me to start w a doxycicline therapy for 10days, instead of going for a 3rd generation cephalosporins or increasing the days of tx to 14-21 days!! What should i do? Should i seek for another doctor, or follow his recommendations?? please help, im a Medical student & i know the Tetracyclines are very strong w/ some serious side effects!
Posted Tue, 17 Apr 2012 in Vaginal and Uterus Health
Answered by Dr. Robert Galamaga 12 minutes later

Thank you for your query. I can appreciate that you have been dealing with a frustrating sequence of events and treatments which have really led to an incomplete resolution of your concern.

Typically antibiotics are the treatment of choice for the smaller cysts but if they do not resolve there are a couple of interventions which can be performed.
The first is what is referred to as a drainage procedure. Drainage of a Bartholin's abscess can be done in the doctor's office or a hospital's Emergency Department. Local anesthetic is injected over the abscess, and then an incision is made on the inner surface of the entrance to the vagina. After the infected material is drained, the abscess cavity is packed either with gauze or a small catheter. This holds the cavity open and promotes further drainage. Gauze packing is removed after 24-48 hours. If a small catheter is used, it may be left in place for several weeks to minimize the chance of recurrence.

The other intervention you may have heard of is called a marsupialization. In a marsupialization an incision is made into the skin over the cyst and then carried down through the cyst wall. This drains the fluid from the cyst and then the lining of the cyst wall is sutured to the overlying skin in such a way as to create a permanent drain site. This usually prevents recurrence of the cyst.

It sounds like you have gotten to the point where some expertise in the form of a minor surgical intervention is warranted. I would either discuss this with your GYN or ask about seeing another gynecologist or gynecological surgeon who has expertise in this area. Finally, if you have not already done so, I would recommend warm baths for 25-30 mins per day. The warm water of the bath can sooth the area and help to shrink inflamed tissue.

I hope you have found this to be informative and helpful. I am available for followup if needed.
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