You've Drained That Bartholin's Cyst Three Times. It Keeps Coming Back. Here's Why.
The Cycle of Return: Frustration for You and Your Patient
She’s back.Third Bartholin’s cyst in two years. Same side. Each time you drained it. Each time it resolved. Each time it came back.She’s frustrated. You’re frustrated. And somewhere in the back of your mind you know there’s a better approach — you just haven’t been formally shown it.
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Beyond the Quick Fix: Why I&D Fails 60% of the Time
Incision and drainage of Bartholin’s cysts has a recurrence rate of over 60%. It is a temporizing measure — not a treatment.Marsupialization is the standard of care. It has a recurrence rate under 10% when performed correctly. It takes under 20 minutes in experienced hands.The reason most OB-GYNs default to I&D is not evidence — it’s familiarity. Marsupialization is rarely taught formally, and even more rarely supervised in residency.
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The Gold Standard: Technical Secrets of Successful Marsupialization
The critical step in Bartholin’s marsupialization is the window size — a minimum of 2.5cm is required to prevent stenosis and recurrence. Smaller windows heal closed, which is why the cyst returns.The suture technique matters as much as the incision: interrupted absorbable sutures everting the cyst wall to the skin edge, not simple closure.Video 11 covers the full marsupialization — including the window sizing, the eversion technique, and the postoperative care that prevents the most common complication: premature closure.
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Stop Draining, Start Treating: Offering Permanent Solutions Today
The next time she comes back with the third recurrence, you’ll have a permanent answer to offer her.Module 4. Six procedures. Including the ones that stop the revolving door.