Marsupialization

What is marsupialization of a Bartholin cyst?

Marsupialization is a surgery that treats Bartholin cysts. Your Bartholin glands are two small glands located on both sides of your labia (vaginal lips), near the opening of your vagina. A Bartholin cyst forms when the opening of a gland gets blocked, causing fluid to build up and creating a lump.

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

Your provider may recommend this procedure if:

• The cyst is extremely painful or uncomfortable.
• You have a history of Bartholin gland cysts returning.
• Less invasive treatments, like a Word catheter, haven’t worked.

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

What happens before marsupialization?

Your provider will explain the procedure. They’ll discuss any risks or complications. You’ll probably need to avoid food (fast) the morning of the procedure. Someone will need to drive you home after.

Don’t hesitate to ask any questions about what to expect.

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 as your surgery. Here’s what you can expect:

1. A healthcare provider gives you anesthesia to prevent you from feeling pain. You can have local anesthesia (the area is numb, but you’re awake) or general anesthesia (you’re asleep for the procedure).
2. You lie on your back, with your legs bent at 90 degrees. Your legs are supported by padded footrests.
3. Your provider cleans the area to prevent infection.
4. They make an incision (cut) the length of the cyst. They drain it and rinse the opened cyst cavity with saline.
5. Finally, they fold the tissue of the exposed cyst backward and stitch it to your skin with dissolvable stitches. The result is a tiny, permanently open pouch or drainage opening where the cyst was. This pouch will allow your Bartholin gland to drain continuously.

Your provider may do a biopsy to test the cyst tissue for cancer cells. Bartholin cyst cancer is extremely rare.

What are the benefits and risks?

Marsupialization has an excellent success rate of treating Bartholin cysts for good. They return in only 5% to 15% of cases.

As with any surgery, there are risks. Possible complications include:

• Pain
• Infection
• Scarring
• Hematoma
• Painful sex

What happens after marsupialization?

Your provider will inspect your wound to make sure there’s no excessive bleeding. They may pack your wound loosely with gauze. 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. Your provider may prescribe pain medications (if your pain is severe) or suggest you take over-the-counter pain medications. They may prescribe antibiotics to prevent infection, but those aren’t always necessary.

You’ll schedule a follow-up appointment for one week after surgery.

What is the recovery time?

Allow two to four weeks for your wound to heal completely. You can return to work after about one week if your job isn’t physically strenuous.

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

• For the first two days: Your wound may feel uncomfortable and painful. But it should gradually feel better. You should be able to eat and drink a few hours after your procedure unless you’re feeling nauseous.
• For up to five days after: You may need to take one or more sitz baths daily. Sitz baths soothe your wound while promoting healing.
• For five days up to 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 feel tired and need pain medication to feel comfortable.

Avoid the following activities for four weeks unless your provider tells you differently:

• Having sexual intercourse
• Inserting tampons
• Using scented soaps, lotions or powders

You can promote healing by:

• Taking medication as your provider prescribes
• Wearing loose, comfortable underwear
• Eating healthy food and drinking lots of water
• Getting enough rest

When should I see my healthcare provider?

Keep any follow-up appointments to make sure that your wound is healing. Call your provider if you:

• Get a fever
• Are bleeding through more than a pantyliner
• Have worsening pain
• Have abnormal vaginal discharge (an unusual color, consistency or smell)