Do Bartholin Cysts Bleed? When to Worry

A simple Bartholin cyst, a smooth fluid-filled lump that hasn’t been opened, usually doesn’t bleed. Blood tends to show up when a cyst becomes infected and bursts, or after it’s been drained, and a little blood mixed into the fluid at that point is common. The exception is a lump in this area that bleeds without having burst, especially after menopause, because the same spot can rarely hide other growths.¹

Why a Bartholin Cyst Might Bleed

Two pea-sized glands sit on either side of the lower back edge of the vaginal opening. They make fluid that helps keep the area moist.² Normally you can’t see or feel them.³ When a gland’s small opening gets blocked, the fluid backs up and forms a cyst.⁴ The blockage may follow an infection or an injury.⁵

If the trapped fluid becomes infected, the cyst turns into an abscess: a painful, swollen pocket of pus. Pressure can make it burst on its own, and the fluid that comes out often looks yellow, green, or blood-tinged. Pain usually eases quickly once it drains.

A burst abscess can be a sudden gush or a slow ooze of pus streaked with blood, often noticed on underwear or toilet paper. The blood appears because the skin over an inflamed abscess is thin and stretched, and the tissue beneath is full of swollen, delicate small blood vessels. When the pocket opens, those vessels leak a little, so the pus often comes out pink or brown rather than plain yellow. The oozing usually tapers over a few days as the pocket empties.

Other things can cause blood too. The skin around the labia can tear during rough or dry sex, and a swollen cyst makes that skin more fragile.⁶ Blood thinners or antiplatelet drugs like aspirin can make a cyst bleed more than expected, as in one reported case of a cyst filled with blood.⁷ Rarely, a bleeding lump in this spot is a tumor rather than a cyst.⁸

If you’re unsure where blood is coming from, wipe gently or use a mirror. Blood from a cyst comes from the lump on one side of the opening, not from inside the vagina. Bleeding from inside the vagina between periods is a separate issue worth mentioning to a doctor.

When Bleeding Means You Should Get Help

These signs call for prompt care, the same day if you can:

Fever, or feeling generally unwell, with a swollen, painful lump, since infection may be spreading through the body.⁹
Redness and warmth spreading into the surrounding skin.¹⁰
Bleeding that soaks a pad in an hour or won’t stop with gentle pressure.
Bleeding while you take blood thinners or antiplatelet medicine.¹¹
Severe pain that keeps you from sitting or walking.

Spotting or streaks on a pad are expected after a burst. Steady dripping or clots are not. If bleeding doesn’t stop with firm pressure from clean gauze, or keeps restarting, get care.

Redness that has visibly moved outward since the day before is a better warning than redness that stays where it began. Marking the edge of the redness with a pen lets you see whether it spreads over the next hours.

Other situations can wait for an appointment in the next few days rather than an emergency visit. A lump that bleeds without having burst or been drained should be examined. A new or growing lump after menopause should be checked even without bleeding.¹² A cyst that keeps coming back after treatment is worth reviewing, since repeat cases may need antibiotics or another approach.¹³

At the visit, tell the doctor when the lump appeared and whether it burst or was drained. Mention any fever, chills, or spreading redness. Give a full list of your medicines, especially aspirin or blood thinners, and say whether you are pregnant or past menopause.

What You Can Do at Home

For a small cyst or mild infection, warm baths, pain relievers, and rest can ease the pain of sitting or walking.¹⁴ Warm shallow soaks a few times a day help a burst cyst keep draining instead of sealing over. Gentle pressure with clean gauze stops minor bleeding.¹⁵

For a soak, sit in a few inches of comfortably warm water, not hot, so delicate skin isn’t scalded. Ten to fifteen minutes a few times a day is a common approach. Plain water is enough, since added products can irritate skin that is already sore. Afterward, pat the area dry with a clean towel instead of rubbing, and use a fresh pad if it is still draining.

A few habits make things worse. Squeezing the cyst or poking it with a needle can push infection deeper and cause more bleeding. Harsh soaps or antiseptics irritate the skin. Avoid sex until it heals, to prevent tears.

Healing follows a fairly steady pattern. Drainage lightens from bloody to clear over several days, and swelling shrinks over one to two weeks. Some small cysts flatten and never cause trouble again.

Antibiotics are usually used when infection spreads into the skin around the gland.¹⁶ When pus is draining, a doctor may swab it to choose the right antibiotic.¹⁷ These infections often involve several kinds of bacteria, so a broad antibiotic is usually tried first.¹⁸

Could a Bleeding Lump Be Cancer

Cancer of this gland is extremely rare, about 1 case per million women each year before menopause in one US region.¹⁹ After menopause the rate is about five times higher, roughly 1 per 900,000 women a year.²⁰ In one hospital follow-up of women over 50 with an enlarged gland, none treated by drainage later developed this cancer over about 10 years.²¹ For a woman with a bleeding lump near the vaginal opening, cancer is a very unlikely explanation, and checking an unexplained one is about thoroughness, not an expectation of bad news.

The most common sign of gland cancer is a lump in this area, which may or may not be painful,, sometimes with bleeding, itching, skin color change, or pain with sex.²² A firm, solid lump can also be a harmless muscle growth that looks like a cyst at first and is only identified after removal.²³ So a lump that feels solid, doesn’t drain, or keeps growing is worth having sampled.

A cyst usually feels smooth and soft and may be tender, while a growth often feels firm or irregular. A lump that doesn’t shrink or change after draining, or after a couple of weeks of care, deserves a second look. So does an open sore on the skin over the lump that won’t heal. None of these features alone proves anything; a doctor weighs them together with an exam and sometimes a sample.

To rule out cancer, a doctor will feel whether the lump is soft and fluid-filled or firm. If it looks unusual, they may take a small tissue sample (a biopsy). An ultrasound or MRI can sometimes show that it is just fluid. Women past menopause are more often offered a biopsy or removal.

Bleeding During and After Treatment

One common treatment is a Word catheter, a small balloon tube placed in the cyst for several weeks so a new opening forms.²⁴ Another, sometimes called the pouch procedure, means cutting the cyst open and stitching the edges to make a permanent pouch that drains.²⁵ The balloon tube takes about 16 minutes and the pouch procedure about 22.²⁶

With the small balloon tube, the balloon is inflated with a little fluid inside the emptied cyst so it stays in place while the opening forms. Light blood-tinged drainage around it is expected early, then usually lightens. If it slips out, call the clinic, since the new opening may already have formed and the doctor can advise whether it needs replacing.²⁷

For the pouch procedure, the doctor opens the cyst, drains it, and stitches the edges of the lining to the skin so the opening stays open. It is done with numbing, and sometimes with sedation or general anesthesia depending on the setting and the person. The stitches usually dissolve on their own. Because the wound heals from the inside, some bloody drainage for several days is expected.

Bleeding during surgery needs an extra stitch in about 1 in 7 traditional surgeries, and about 1 in 17 with laser surgery.²⁸ Infection afterwards happens in about 3 to 5 in 100 people.²⁹ Medicines that thin blood may be paused briefly around the procedure, in one case for 3 days.³⁰ Never stop them on your own, because stopping without advice can raise the risk of clots or stroke. Ask the doctor who prescribed them, and bring a full medication list to the visit. Call if the bleeding gets heavier rather than lighter.

Will It Come Back

In a large comparison, about 12 in 100 cysts came back after the balloon tube and 10 in 100 after the pouch procedure.³¹ Another study found the cyst returned in about 19 in 100 after the tube versus 8 in 100 after the pouch.³² In one smaller group, the tube worked in about 9 in 10 people.³³ The numbers differ because studies vary in who they include, how they define a recurrence, and how long they follow people.

If a cyst does return, the pouch procedure may suit repeat cysts, and removing the gland is a last option for frequent returns. It’s reasonable to ask which method your doctor uses most often. A return is not a sign of cancer by itself.

To reduce the chance of another flare, treat early swelling with warm soaks and use lubrication during sex to prevent skin tears. If painful swelling starts again, see a doctor early.

Bleeding Cysts in Pregnancy and Effects on Sex

About 1 in 800 pregnant women gets an abscess of this gland, most often in the second trimester, though a cyst can appear at any stage.³⁴ Serious infections in mother or baby were not seen in one group of 40 pregnant women.³⁵ Safer antibiotic choices are used in pregnancy.³⁶

If you are pregnant and have a bleeding cyst, tell your midwife or doctor promptly. Fever in pregnancy always needs a same-day check. Draining an abscess is a small procedure that can be done during pregnancy, usually with local numbing. Tell whoever does it that you are pregnant, even if it’s early and not obvious.

Gland problems can also affect intimacy. About half of women with them had sexual difficulties, and many felt worried about their genitals.³⁷ These improved significantly after treatment.³⁸

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