NHS GP & Women’s Health Specialist

Dr Sylvia Kama-Kieghe

You’ve found a swollen lump on one side of your vaginal opening and you’re Googling at midnight trying to figure out if it’s serious.

Here’s the honest answer: it depends on one key distinction — and most women are never told what that distinction is. By the end of this post, you will know exactly what you are dealing with, what to do tonight, and the exact red flags that mean you stop reading and go straight to A&E.

Watch First: Bartholin Cyst Vs Abscess: 7 Things You Need to Know Before It Gets Worse

First — What Are the Bartholin Glands?

Most women have never heard of these until one of them causes a problem.

The Bartholin glands are two tiny glands, one on each side of the vaginal opening, sitting at roughly the 4 o’clock and 8 o’clock positions. Their only job is to produce a small amount of fluid to keep the vaginal entrance lubricated.

You cannot feel them when they are healthy. You will only know they exist when something goes wrong with one of them — which is exactly what a Bartholin cyst is.

# 1 — What a Bartholin Cyst Actually Is (and What It Is Not)

A Bartholin cyst forms when the duct — the small tube that drains fluid out of the gland — gets blocked. Usually this happens because the mucus inside the duct thickens up. Fluid then backs up behind the blockage and a fluid-filled sac forms.

That sac is the cyst. It is not cancer or an STI. It is not caused by anything you did or didn’t do. Simply, it is a blocked gland — that is all.

Size range: From the size of a pea to, in some cases, as large as a golf ball.

At the cyst stage, it is typically:

• Smooth and soft to touch
• Sitting on one side only — never both sides at the same time
• Painless or only mildly uncomfortable at rest
• More noticeable during sex, walking, or prolonged sitting

# 2 — How a Cyst Becomes an Abscess

This is the critical line that changes everything. A Bartholin abscess is what happens when bacteria get into the cyst. The cyst becomes infected. The fluid inside turns to pus.

That one word — infected — is the difference between something you can manage carefully at home and something that needs medical attention today.

The bacteria most commonly involved include:

• Bacteria that normally live on the skin surface
• E. coli (from the bowel area)
• Occasionally sexually transmitted bacteria like gonorrhoea (though most Bartholin abscesses are not caused by STIs — this is a common misconception)

# 3 — How to Tell the Difference: Cyst vs Abscess

This is the table that matters most. Read it once and remember it.

The single most reliable indicator: are you in pain just sitting still, without touching the lump? If yes — that is almost certainly an abscess and it needs to be seen today.

# 4 — The Red Flags That Mean A&E Right Now

Do not finish this post. Open a new tab and find your nearest A&E or urgent care if any of the following apply to you right now.

Go to A&E Today If:

If the abscess bursts on its own before you get there — still go. You still need antibiotics and a proper assessment to make sure it has drained fully.

# 5 — Home Treatment for a Simple Cyst

If you have confirmed this is a cyst — no red flags, no fever, no severe pain at rest — the first-line treatment is simple.

Warm sitz baths:

1. Run a shallow bath of comfortably warm water — just enough to cover the vulval area
2. Sit in it for 10–15 minutes
3. Repeat 3–4 times per day
4. Continue for several days

The warmth encourages the blocked duct to soften and open naturally, allowing the fluid to drain on its own. Many small cysts resolve completely with this approach alone.

Important: Warmth only works for an uninfected cyst. Applying heat to an abscess will make it bigger, more painful, and risks the infection spreading further. If you are not sure whether you have a cyst or abscess — use the table above, and if still unsure, see your GP before starting home treatment.

Watch: Bartholin’s Abscess — When a Cyst Gets Infected | 12 Facts Explained

# 6 — Medical and Surgical Treatment Options

When a sitz bath isn’t enough — or when you arrive at your GP or A&E with an abscess — here is what treatment looks like.

Word Catheter Procedure

The most common first-line procedure for both symptomatic cysts and abscesses.

What happens:

• A small incision is made into the cyst or abscess under local anaesthetic
• The fluid or pus is drained
• A tiny balloon-tipped tube — the Word catheter — is inserted into the opening
• The balloon is inflated inside the gland to keep the channel open
• The catheter stays in place for 4–6 weeks while your body forms a new permanent drainage duct
• You can usually go home the same day

What to expect: Some discomfort and discharge while the catheter is in place. You can shower normally. Avoid baths and swimming until it is removed.

Marsupialization

A more involved surgical procedure, usually done under general anaesthetic for larger abscesses or recurrent cases.

What happens:

• A larger incision is made and the lining of the cyst is stitched open permanently
• This creates a new, lasting drainage channel so the gland can drain normally going forward

Recovery: A few days of discomfort, typically managed with simple painkillers. Usually done as a day case.

Antibiotics — An Important Clarification

Antibiotics alone are almost never sufficient to treat a Bartholin abscess. Pus needs to be drained. Antibiotics cannot penetrate a walled-off collection of infected fluid. They are used alongside drainage — not instead of it. If a doctor tries to treat your abscess with antibiotics only and send you home — ask specifically whether it also needs to be drained.

# 7 — Prevention and What to Do If It Keeps Coming Back

A Bartholin cyst can recur — especially after a first episode. Here is what the evidence supports to reduce that risk:

• Wear cotton underwear — reduces friction, heat, and moisture around the vulval area
• Avoid perfumed products near the vulva — no scented wipes, feminine washes, or bubble baths
• Stay well hydrated — dehydration thickens mucus secretions throughout the body, including in the Bartholin duct
• Attend all follow-up appointments after any procedure — your GP needs to confirm the drainage channel is staying open
• Do not squeeze or try to drain the cyst yourself — this pushes bacteria deeper and significantly increases your risk of abscess

If It Keeps Coming Back

If you have had three or more episodes of an infected Bartholin cyst or abscess — ask your GP for a referral to gynaecology.

Repeated infections suggest the drainage duct is not staying open long-term, and a more definitive surgical solution (such as complete removal of the gland) may be the right conversation to have.

NHS: Bartholin’s Cyst — Symptoms, Causes and Treatment

The Bottom Line

A Bartholin cyst is a blocked gland — not cancer, not an STI, and not your fault.

Most small cysts resolve with warm sitz baths and a watchful eye. The moment it becomes infected and turns into an abscess, the rules change completely — that is an A&E visit, not a wait-and-see.

Use the red flag table in this post to make that call with confidence, and never let anyone send you home with antibiotics alone if there is pus that needs draining. You deserve a proper assessment — and now you have the words to ask for one.

Have you been through a Bartholin cyst or abscess and wish you had known this sooner? Tell me below this post — your story helps the next woman who finds this at midnight. → Join the free AskAwayHealth community →

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