Marsupialization

What is marsupialization of a Bartholin cyst?

Marsupialization is a surgery used to treat Bartholin cysts. Your Bartholin glands are two small glands located on both sides of your labia (vaginal lips) near the opening of your vagina. They secrete fluid that helps lubricate your vagina. Bartholin cysts form when a blockage occurs at the opening of one of these glands, causing fluid to build up and form a lump.

With marsupialization, your provider cuts a slit into a Bartholin cyst, allowing it to drain. Then, they suture the edges of the cyst to the surrounding tissue to form a tiny pouch. The pouch allows the fluid from your Bartholin gland to drain freely.

Why is this treatment used?

Marsupialization may be an option if you have a cyst that hasn’t resolved with less invasive options. Not all Bartholin cysts need treatment. Even if they do, marsupialization isn’t usually the first treatment your provider will suggest.

Your provider may recommend marsupialization if:

• Your cyst is extremely painful or uncomfortable.
• You have a history of Bartholin gland cysts returning after treatment.
• More conservative treatments, like a Word catheter, haven’t resolved your cyst.

Word catheters and marsupialization have similar success rates. During treatment with a Word catheter, your provider inserts a catheter into your cyst that creates a passage where fluid can drain. Because inserting a Word catheter is less invasive and less expensive than marsupialization, your provider will likely recommend this procedure first.

If your cyst grows back after a Word catheter and marsupialization, your provider may recommend removing your Bartholin gland (excision). Excision is a last resort because it involves more risks, like excessive bleeding during surgery.

What happens before marsupialization?

Your provider will explain the procedure to you and obtain your consent before proceeding. They will:

• Review your medical history to ensure you’re a good candidate for marsupialization.
• Discuss any risk factors or potential complications.
• Offer instructions on how to prepare for the procedure and plan your recovery.

For instance, depending on the anesthesia your provider uses, you may need to arrange for someone to drive you home afterward. You’ll also need to request time off from work to allow yourself adequate time to recover.

What happens during marsupialization?

Marsupialization lasts about 10 to 15 minutes and usually takes place in an operating room. You should be able to go home the same day of your surgery. During the procedure, your provider will:

1. Place you in a dorsal lithotomy position on a table. You’ll lie on your back, with your legs bent at 90 degrees and supported by padded footrests.
2. Administer an anesthetic to prevent you from feeling pain. Marsupializations can be performed under local anesthesia (the area near the surgery site is numb and you’re awake) or general anesthesia (you’re asleep for the procedure).
3. Clean the surgical site, including your perineum (the space in between your vaginal opening and your anus), to prevent infection.
4. Make an incision (cut) the length of the cyst, drain it and rinse the opened cyst cavity with saline.
5. Fold the tissue of the exposed cyst backward and suture it to the nearby skin on your vulva. The sutures will dissolve over time. The result is a tiny open pouch that’s continuous with the surrounding skin. This pouch will allow your Bartholin gland to drain continuously.

Once your cyst is opened, your provider will inspect the cyst walls for any tissue showing cancer signs. If needed, they can perform a biopsy to test the tissue for cancer cells.

Bartholin cyst cancer is extremely rare (5% of cancers affecting the vulva). You’re at greater risk if you have a cyst and you’re over 40.

What does the surgery site look like after marsupialization?

After marsupialization, your cyst will no longer be a fluid-filled sac. Instead, it will be a tiny pouch, about a quarter of an inch in size.

What happens after marsupialization?

Your provider will inspect your wound to ensure there’s no excessive bleeding. They may pack your wound loosely with gauze, but usually, you can wear a sanitary pad to manage the blood from your wound.

You may be in a recovery room for a few hours before your provider releases you to go home. Before releasing you, your provider may prescribe pain medications (if your pain is severe) or suggest you take over-the-counter pain medications. Your provider may prescribe antibiotics to prevent infection, but often antibiotics aren’t needed after marsupialization.

Plan for a follow-up appointment one week after surgery.

What are the advantages of marsupialization?

Marsupialization has an excellent success rate of resolving Bartholin cysts for good. Bartholin cysts return after marsupialization in only 2% to 13% of cases.

What are the complications of marsupialization?

As with any surgery, there are risks involved with marsupialization, but complications are rare. Complications include:

• Pain.
• Infection.
• Scarring.
• Hematoma (blood that collects at the surgical site).
• Pain during intercourse (dyspareunia).

What is the recovery time for marsupialization of a Bartholin cyst?

Allow yourself two to four weeks for your wound to heal completely.

What’s the recovery period like?

Follow your provider’s instructions on cleaning and caring for your wound. Expect the following:

• For the next day or two: Your wound may feel uncomfortable and painful but should gradually begin to feel better.
• For the next three to five days: You may need to take one or more sitz baths daily. Sitz baths soothe your wound while promoting healing.
• For the next two weeks: You may notice a small amount of bleeding or vaginal discharge. A panty liner should be enough to manage the bleeding. You may also become fatigued easily and need to take pain medications regularly.

You can promote healing during the recovery period by:

• Taking prescribed medications.
• Wearing loose, comfortable underwear or jeans.
• Eating healthy food and drinking lots of water.
• Getting enough rest and avoiding overexertion.

Are there any activities I should avoid while I recover?

Plan to avoid the following activities for four weeks unless your provider instructs you differently:

• Having sexual intercourse.
• Inserting tampons.
• Using scented soaps, lotions or powders that may irritate your wound.

When can I eat normally?

You should be able to eat and drink a few hours after your procedure unless you’re feeling nauseated. As soon as the next day, you should be able to eat small regular meals.

When can I go back to work?

Most people can return to a job that isn’t physically strenuous after about a week after surgery. If your job is more strenuous, you may need two or more weeks to heal before returning to work.

When should I see my healthcare provider?

Keep any follow-up appointments to ensure that your wound is healing as it should. In addition, see your provider if:

• You get a fever.
• You’re bleeding more than a pantyliner can handle.
• You’re experiencing pain at your wound site that’s worsening.
• You have an abnormal vaginal discharge (an unusual color, consistency or smell).

A note from Cleveland Clinic

Marsupialization can help you get rid of a recurring cyst that’s making you uncomfortable. It is a more involved procedure than more common treatments, like Word catheter insertion. Still, it’s a relatively minor surgery. With marsupialization, you can get rid of the cyst while keeping your Bartholin glands intact. Speak to your provider about the outlook of marsupialization based on your medical history with Bartholin cysts.