What is Marsupialization?
Marsupialization is a surgical procedure used to treat Bartholin’s cysts.
Bartholin’s glands are tiny organs on the labia near the vaginal opening. The glands help provide lubrication for sexual intercourse.
Under normal circumstances, you’d probably never notice these glands. But sometimes, skin grows over the opening of the gland, trapping fluid inside. A buildup of fluid results in a cyst.
If you have a small Bartholin’s cyst, there’s a good chance that it’s painless.
However, they can grow large enough to cause discomfort and pain. They can occasionally become infected or abscessed. In those situations, your doctor will likely recommend treatment.
Marsupialization is also used to treat other types of cysts, such as Skene duct cysts, which develop near the opening of the urethra.
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Before Marsupialization Surgery
Why it's done
Marsupialization is often used to treat cysts that form in the Bartholin’s glands. These are a pair of small, pea-sized glands found just inside the vagina that secrete lubricating fluid during sexual intercourse.
The fluid travels into the vagina down tiny tubes called ducts. If these ducts become blocked, they can fill with fluid and form a cyst.
No one knows for sure why these ducts get blocked and develop cysts. In rare cases, sexually transmitted infections may cause Bartholin’s cysts.
Doctors may recommend marsupialization if a person has a history of recurring Bartholin’s gland cysts, or if the cysts cause significant pain. It is also a good treatment option in situations where other treatments have failed.
Marsupialization is an effective treatment that has few risks. Doctors will not carry out the procedure if there is an abscess present, however. Sometimes the surgery is recommended but does not go ahead because the person declines the treatment.
While Bartholin’s gland cysts are the focus of this article, marsupialization is also used to treat pilonidal cysts. These cysts occur at the bottom of the tailbone or coccyx. They are more common in males than females, and many doctors think that ingrown hairs are the most likely cause.
Who’s a good candidate for this surgery?
Marsupialization isn’t usually the first-line treatment. It’s a good option when other treatments haven’t worked.
Your doctor may recommend marsupialization if:
. Cysts keep recurring
. You’re in a lot of pain
. Your cyst is large enough to interfere with sitting, walking, or sexual intercourse
. You get cysts that become infected and abscessed, which can cause pain and fever
. You currently don’t have an abscess
If the cyst is irregular or bumpy, or you’re over 40 years old, your doctor may recommend a biopsy to rule out cancer.
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When to see a doctor about a cyst
A person should see their doctor if they have any or all of the following symptoms:
. A painful, swollen lump
. No improvement after 3 days of home treatment
. Pain is severe enough to disrupt daily activity
. Cyst becomes an abscess
. A fever of more than 38°C
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Risks and Complications
What are the possible complications of Marsupialization Surgery?
Complications from marsupialization are rare, but may include:
. Recurring abscesses
. Unresolved pain
Contact your doctor if:
. You develop a fever
. Are bleeding more than expected
. Show signs of infection
. Have unusual vaginal discharge
. Have pain that’s getting worse
During Marsupialization Surgery
What happens during the procedure?
The procedure can vary a bit from doctor to doctor. Be sure to discuss the specifics in advance, so you have an idea what to expect.
You might not be able to drive immediately after the procedure, so arrange transportation beforehand.
Marsupialization can be done in your doctor’s office or in an outpatient facility, usually under local anesthesia. This means only the area being worked on will be numb so you don’t feel any pain.
In some cases, your doctor may prefer to use general anesthesia. This means you’ll be asleep during the procedure and not feel any pain.
The procedure would be done in a hospital setting, but it generally wouldn’t involve an overnight stay. If general anesthesia is used, you’ll be given instructions about when to stop eating and drinking prior to the procedure.
At the start of the procedure, the cyst and surrounding area will be cleaned and sterilized. Then the doctor will use a scalpel to make a cut on the cyst, through which fluid will be drained.
Your doctor will stitch the edges of the skin in a way to leave a small, permanent opening through which fluids can drain freely.
Immediately after the procedure, gauze will be used to prevent bleeding. In some cases, your doctor may leave a catheter in place for a few days to allow more drainage.
The procedure itself takes about 10 to 15 minutes. However, you may be in the recovery room for a few hours before you can go home.
What are some other treatments?
A Bartholin’s cyst doesn’t always need treatment, especially if it’s not bothering you and isn’t infected. Even if it’s painful or uncomfortable, marsupialization may not be necessary.
Your doctor may recommend some of these methods first:
. Warm soak. Soak the cyst in warm water for 10 to 15 minutes a few times a day for 3 or 4 days. You can do this in a sitz bath or bathtub. This can help the cyst rupture and drain. Alternatively, you can hold a warm compress on the area.
. Surgical drainage. Under local anesthesia, your doctor can make a small incision to insert a small catheter called a word catheter. It will stay in place for 4 to 6 weeks to drain the fluid. Then you’ll need to return to the doctor’s office to have the catheter removed.
You can also use over-the-counter pain relievers. Your doctor may prescribe an antibiotic if there are signs of infection.
If no other methods work, the Bartholin’s gland can be surgically removed. This surgery is usually done under general anesthesia and may require a few days in the hospital.
After Marsupialization Surgery
You may have mild pain and discomfort for a few days. Your doctor might prescribe oral antibiotics to prevent infection. You can also take over-the-counter pain relievers.
A small amount of discharge or minor bleeding for a few weeks is normal. A pantyliner is usually sufficient enough to handle this.
Follow your doctor’s instructions for cleaning and caring for the area. This may include taking one or two sitz baths a day for a few days.
Until you’re fully healed and your doctor gives you the go-ahead, don’t:
. Engage in sexual activity
. Use tampons
. Use powders or other similar products
. Use harsh soaps or fragranced bathing products
You should be able to resume normal activities within 2 to 4 weeks.
Follow up with your doctor as recommended to ensure that you’re healing properly.
. Take it easy for several days
. Wear comfortable, breathable underwear
. Be careful to wipe from front to back after using the toilet
The following courses of action are recommended to ensure that no complications occur during the recovery period after surgery:
. Avoiding sexual intercourse and using tampons for 4 weeks after surgery
. Keeping the affected area clean and dry
. Washing every day with warm soapy water
. Wearing cotton underwear and avoiding tight clothing
. Taking prescribed medication and attending all follow-up appointments
. Eating normally and drinking lots of water
. Avoiding strenuous activities and getting lots of rest
Around 1 in every 50 women will develop a Bartholin’s cyst or abscess. Sexually active women aged between 20 and 30 are most likely to develop them. Not all of these women will require marsupialization, however.
Following the procedure, you should be back to normal activities within a few weeks.
Marsupialization of a Bartholin’s cyst makes recurrence less likely than it is after other procedures.
According to research, about 5 to 15 percent of Bartholin’s duct cysts recur after marsupialization.