Bartholin cysts affect about 2% of women at some point in their lives. That makes them one of the more common vulvar conditions, though most women will never experience one. They occur most frequently around age 30 and are rare before puberty and after menopause.
Who Gets Bartholin Cysts
The Bartholin glands are two small, pea-sized glands located on either side of the vaginal opening. Their job is to secrete fluid that helps with lubrication. When the duct of one of these glands gets blocked, fluid backs up and forms a cyst. The blockage can result from infection, injury, or inflammation, though in many cases no clear cause is identified.
The peak incidence is in women of reproductive age, with an average age of diagnosis around 30. They’re uncommon in adolescents and become increasingly rare after menopause, likely because the glands naturally shrink and produce less fluid with age. There’s no strong evidence linking Bartholin cysts to specific sexually transmitted infections, though bacterial infections can contribute to abscess formation once a cyst is already present.
What They Feel and Look Like
A Bartholin cyst can range from the size of a pea to the size of a golf ball. Small cysts often cause no symptoms at all and may only be noticed during a routine exam. Larger cysts typically create a noticeable lump on one side of the vaginal opening that can make sitting, walking, or having sex uncomfortable.
When a cyst becomes infected, it turns into an abscess. Abscesses are painful, often intensely so. The area becomes red, swollen, and warm to the touch, and you may develop a fever. The shift from painless cyst to painful abscess can happen quickly, sometimes within days.
How Often They Come Back
Recurrence is one of the most frustrating aspects of Bartholin cysts. The rate depends heavily on how the cyst is treated. Simple incision and drainage, the most straightforward approach, carries a recurrence rate of nearly 40%. That’s because cutting the cyst open and draining it doesn’t create a permanent opening for the duct, so fluid can build up again once the incision heals shut.
More definitive procedures perform significantly better. Marsupialization, where a surgeon creates a small permanent pouch to keep the duct open, has a recurrence rate of only 2% to 13%. A Word catheter, a small balloon-tipped tube inserted into the cyst and left in place for several weeks to form a new drainage channel, has similar success rates to marsupialization. Both approaches work by giving the gland a new path to drain through rather than simply emptying the cyst once.
Managing a Cyst at Home
Small, uninfected Bartholin cysts often resolve without any medical procedure. Soaking in a few inches of warm water (a sitz bath) several times a day for three to four days can help a cyst drain on its own. The warmth increases blood flow to the area and softens the tissue around the blocked duct. Many women find that this is enough to resolve the problem, particularly with smaller cysts that aren’t yet causing significant pain.
If a cyst doesn’t respond to sitz baths within a few days, grows larger, or starts showing signs of infection (increasing pain, redness, warmth, or fever), that’s the point where medical treatment becomes necessary. Infected cysts rarely resolve on their own and tend to get worse without intervention.
Cancer Risk Is Extremely Low
One concern women sometimes have, particularly those over 40, is whether a Bartholin gland lump could be cancerous. Bartholin gland carcinoma is exceedingly rare in all age groups. In premenopausal women, the incidence is 0.023 per 100,000 woman-years. In postmenopausal women it’s roughly five times higher, but still only 0.114 per 100,000 woman-years. To put that in perspective, a postmenopausal woman is far more likely to develop other types of vulvar cancer than Bartholin gland cancer specifically.
A study tracking postmenopausal women who had Bartholin gland enlargement treated with drainage or marsupialization (rather than full excision) found that none of them went on to develop Bartholin gland cancer over a median follow-up period of more than 10 years. That said, providers sometimes recommend a biopsy for new Bartholin gland masses in women over 40, simply because the baseline risk of vulvar cancers increases with age and ruling it out is straightforward.
What Treatment Looks Like
For cysts that need medical attention, treatment follows a general progression based on severity and recurrence. A first-time cyst or abscess is often treated with incision and drainage, sometimes with a Word catheter placed at the same time. The catheter stays in for four to six weeks while a new drainage tract forms around it. During that time, most women can go about normal activities, though the catheter can occasionally feel awkward or fall out early.
For recurrent cysts, marsupialization is the next step. This is a minor surgical procedure, typically done under local anesthesia, where a small permanent opening is stitched into the cyst wall. Recovery takes a couple of weeks, and the recurrence rate drops substantially compared to simple drainage. Complete removal of the Bartholin gland is reserved for cases that keep coming back despite other treatments. It’s a more involved surgery with higher risks of bleeding and scarring, so it’s generally a last resort.