2 Prepare the labia and vagina with the antiseptic solution. It is preferable to enter the cyst (Fig. 131-2A) or abscess from the vaginal side of the introitus unless this would require a much deeper incision (Fig. 131-2B). Inject lidocaine over the intended site of entry. If the incision is to be made external to the introitus where the abscess is “pointing,” plan to insert the catheter approximately in the area of the original duct orifice, immediately adjacent the hymenal ring (Fig. 131-2C).

3 Lance or incise the cyst or abscess with a no. 11 scalpel blade (see Fig. 131-2C). It is essential that the stab wound penetrate the cyst or abscess wall, which will be evidenced by the free flow of pus or mucus. Culture contents if indicated. Although the majority of simple cysts are sterile, abscesses are typically polymicrobial, and many others contain Neisseria gonorrhoeae. Culture usually will not change initial management. The stab wound must be just large enough for the catheter to be inserted, usually 3 to 4 mm.