I just had CO2 ablation surgery for my recurring Bartholin's cyst

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There is a procedure that many gynecologists do not know about: CO2 ablation for Bartholin's cysts. I have been dealing with a recurring Bartholin's cyst for 4 years. I hope this information helps those who are struggling to find the right treatment.

In 2018, I had a Bartholin's cyst and it was causing lots of pain and chafing. My gynecologist recommended lancing it and using a Word catheter to drain it, which is standard procedure. I did this and it was a very painful recovery. Walking around for 2 weeks with a catheter inserted in your vulva just plain hurts. The plan is that when the catheter is removed, a permanent hole will remain so that the cyst can drain freely if it ever comes back.

From my observation and experience, there are three problems with the Word catheter treatment:

  1. The procedure treats the SYMPTOM, not the problem. The PROBLEM is the cyst, not the fluid in the cyst. By allowing the cyst fluid to merely drain, the cyst wall is STILL THERE and can still become a problem.
  2. Like when you get your ears pierced, if you take the earrings out of the hole, the hole can close up. It did for me, and that cyst came back within a year.
  3. Lancing leaves scar tissue, which can have some bulk to it. So repeated lancing means more scar tissue.

When the cyst came back, my gynecologist recommended marsupialization. For those who are not familiar, that is a procedure where they cut an opening in the vulva at the cyst site and essentially stitch it back onto itself so that the hole remains open, like a pouch. (Poor explanation but there are plenty of pics on Google that illustrate.) Again, this procedure treats the symptom. That procedure and recovery sound brutal, and I thought, there must be other options out there.

I researched and found a procedure called CO2 laser ablation. In this procedure, the doctor uses a microscopic laser to go up into the Bartholin's gland, FIND THE CYST, and ablate (laser blast) the cyst wall. The procedure is minimally invasive, meaning much easier on your body, minimal cuts to tissue, and a much easier recovery. This procedure also leaves the remaining part of your Bartholin's gland to continue functioning, minus the small portion that was ablated by the laser (the portion that was previously out of commission due to the cyst).

I was only able to find two doctors in the US who do this procedure, likely due to the costly equipment it requires:

Dr. David Ghozland in Los Angeles, CA

Dr. Kevin Stepp in Charlotte/Pineville, NC

The consultation

A few months ago, I drove from out of state to NC and met with Dr. Stepp for a consultation. I was blown away by his expertise and experience. He answered all my questions in great detail, explaining the whole range of least invasive methods to most invasive methods (like marsupialization), and the pros/cons of each. I will save that information for another post. He determined I was a good candidate for CO2 ablation, and I was scheduled to have the surgery 3 months later.

The surgery

I had the surgery 1 week ago (March 2022). They DO put you under anesthesia so there is no memory of the surgery at all. The experience with Dr. Stepp and his team, and the hospital overall, was second to none. Completely awesome experience, I was so impressed. I was comfortable the whole time, and the team was SO well coordinated and professional. I did not feel an ounce of pain even after the surgery. Let me repeat that: NO PAIN.

The recovery

I took it easy for 3 days (including day of surgery) and waited for the pain to come, but it never did. All I used was ibuprofen and stool softeners during recovery. I think the most I experienced was a bit of discomfort and throbbing after trying to sit for a while to eat, but that didn't even register on the pain scale. So you just lay down, ice it, and relax. The nurses actually encourage you to walk around a bit after surgery since blood flow helps with recovery. The next day we went to the mall and I hobbled around for a couple hours for some exercise, so that should give you an idea. Not bad AT ALL.

3 days after surgery I flew home. You're not supposed to lift anything over 10 lbs so I only carried what was necessary in my backpack and shipped the rest home. Sitting on the flights wasn't too bad, I just scooted low in my seat on my tailbone to take the pressure off. The area did have soreness and throbbing the next day to remind me that it did not like being sat on. I iced it and took ibuprofen, and the next day I was fine.

It is now 1 week after surgery. I can drive (while laid back a bit in my seat) or sit for about 20 mins at a time before getting uncomfortable. I can go out, I can shop, I can cook, I can do whatever within reason. I still am not lifting/carrying more than 10 lbs, probably for another week. I feel pretty good, just making sure I go for walks to keep blood flowing and healing. Thankfully I have a standing desk for work, so I can work while standing and went back to work the day after returning home.

Expenses

I understand everyone does not have the flexibility or the resources to make something like this happen. I am very grateful and fortunate to have been able to do this, and it was covered by my health insurance. I'm not sure yet what the final bill will be. It was a coordinated effort for me to have a caretaker after surgery, and paying for travel gets expensive. But, it's tax deductible since it's for a medical procedure so that's something to consider if you have a health savings account. Save your travel receipts and submit them for reimbursement if you can.

What's next?

My hope is that this procedure solves the PROBLEM. The cyst wall is the problem, and that cyst wall is now gone. There's still a small chance that a new cyst can occur (the Bartholin's gland is actually made of many smaller parts that can each develop a cyst) but I'm hoping for the best and I have utmost confidence in Dr. Stepp and his team. I plan to post more info such as:

  • Some of my Q&A with Dr. Stepp
  • Bartholin's gland anatomy - why the cyst can come back
  • Detailed experience having the CO2 ablation procedure
  • Follow up months after surgery - how did it turn out?

Please let me know if any of those topics are of interest and I'll write more. This is already way too long but I want to help get the word out about this procedure and amazing team who helped me. Thank you for your time reading, and best of luck to you in your journey seeking relief from this condition. Help is out there. ❤️

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3 Replies

  • Posted

    Hi,

    Thank you for posting about this. It's been very useful. How are you feeling now? Best wishes, Alex

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    • Posted

      Hi Alexandra,

      It has been nearly 4 months since my surgery and I am feeling pretty good. The healing over all took much longer than I was anticipating, and it continues today. The steps of healing have been slow for me, but I think it is still moving in a good direction. After 4 months I am starting to finally have sex again at the level of "intensity" that I was able to have it when I had the discomfort of the cyst several years ago, before it got big and cumbersome. I haven't reached my personal baseline yet, so I know I still have work and healing to do. My baseline for feeling "normal" again is that I hope to be worry-free of any pain during intercourse, and a manageable amount of pain after. That's how it always was for me, and that is what success looks like personally for me. If I can have no pain after as well, then that would be a huge success for me.

      I'll talk a bit more about my healing experience. My surgeon told me after 6 weeks I would be able to have sex again. For me, that was not even something I wanted to do at 6 weeks. I didn't want anything near it. It was tender and sensitive.

      Weeks after surgery:

      1 - Able to walk around, drive up to 20 mins while sitting on orthopaedic seat cushion

      2 - Able to lift 10 lbs (resume more normal house chores & shop)

      3 - Able to sit for a couple of hours at a time, still needing ice afterwards (fly on airplane, drive, sit-down dining)

      4 - Stopped needing ibuprofen tabs for the swelling. Able to sit down for work (using orthopaedic cushion)

      6 - Orthopaedic cushion no longer needed. Began physical therapy using vibrating dilator to desensitize the area (helps w/ my vulvodynia). Pain felt like there was a zit inside my vagina at scar site. Sharp pain like when you touch a monster whitehead zit that is already sore. I inspected the scar w/ a mirror and observed a small knot-like area, smaller than a pea. I continued doing PT with my dilator and gradually the pain went away.

      8 - Scar knot no longer visible & felt more like a rawness than a pain. Able to have sex for the first time following surgery. Very slow, gentle, deliberate moves. Continued attempting sex for the 6 weeks & each time was different. Sometimes it hurt, sometimes not as much. Learned to be very in-tune with what each type of pain was telling me, such as whether it was throbbing because the whole area was sore, or it was irritated from chafing scar tissue.

      15 - Able to have sex for the first time since surgery that felt as good as it did before surgery, and even before the cyst got really bad. Major improvement, although I did experience swelling afterwards and some chafing.

      The most difficult part of this journey has actually not been the physical healing part. It has been the psychological and emotional weight of not knowing if/when I would get positive results. It has put a strain on my relationship because of the hope/expectation that I "should" be back to "normal" 6 weeks after surgery. Each body is different, and each relationship is unique, and not hitting that mark at 6 weeks was disappointing and frustrating for us both. We each handled it in our own way but it has been hard. A situation like this can bring out insecurities on both sides. Thankfully I am working through mine with a therapist and continuing to do my PT. But I won't lie, it's a hard thing to go through with a partner, after months turn into years dealing with this issue. I feel like we are finally seeing the light at the end of the tunnel now but I know I have to stay on top of my PT to keep the progress I've made.

      I personally believe that I won't feel 100% until maybe a year after the surgery. I think there will be scar swelling that will gradually go away over time, and until that happens, there will probably continue to be chafing. But, it's already so much better than before my surgery, and I hope to one day be better to the point it was before I ever had the cyst. It's scary to wonder, is it scar tissue or is the cyst returning?? But knowing my body and feeling the rate at which the swelling comes and goes, I believe it is just the natural process of scar tissue healing.

      I hope this post helps, thank you for reading!

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  • Posted

    Update - It is 19 weeks after my surgery. I finally had sex that was great, without my partner holding back, and with no pain or discomfort. My repaired bartholin's gland was definitely working and both me and my partner felt the difference with all the "juices flowing" 😃. I feel very hopeful that as long as I continue my physical therapy exercises with my dilator that I will continue to make progress. The scar tissue feels less noticeable as the weeks go by.

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