What Are Vaginal Cysts

Introduction

Vaginal cysts are a common gynaecological condition that can affect women of all ages. These cysts are sacs of tissue that may be filled with air, fluid, pus or any other substance that develops within or around the vaginal walls. While they may not always cause noticeable symptoms, sometimes they can get infected and cause inflammatory symptoms that require medical attention.¹

Vaginal cysts can vary in size, shape, and location within the vaginal canal. They develop when the mucous glands or ducts in the vaginal wall become blocked, causing fluid accumulation. While the majority of vaginal cysts are benign (non-cancerous), some may grow in size and potentially pose health risks.²

Understanding the different types of vaginal cysts, their causes, symptoms, and available treatment options is essential for women's reproductive health and overall well-being. 

Types of vaginal cysts

The vaginal cysts are classified according to histology, meaning according to the lining epithelium of the cyst wall.

Inclusion cysts 

Inclusion cysts of the vagina are also known as epidermal cysts. Inclusion cysts are formed by the inclusion or trapping of vaginal secretions or other substances within the vaginal wall. 

They are slow-growing tumours which do not cause any symptoms. These cysts are typically small and painless but can sometimes cause discomfort or become noticeable due to their size. 

They can appear spontaneously or due to a trauma such as childbirth. A histopathological exam is carried out to find out if the tumour is benign or malignant.³

Gartner's duct cysts

Gartner's ducts are embryonic structures that develop in female fetuses and eventually regress during fetal development, but in some females, they can persist and form cysts. Gartner's duct cysts are rare and are typically found in the walls of the vagina and are considered congenital, meaning they are present at birth but may even appear in late middle age.⁴

These cysts are generally asymptomatic but some patients can experience skin tags, painful urination, pressure, itching, or pelvic pain.⁵

This can be diagnosed with Magnetic Resonance Imaging (MRI), but general pelvic examination and transvaginal ultrasound can be used for management.⁴

Bartholin's cysts

Bartholin's cysts are fluid-filled sacs that can develop in the Bartholin's glands, which are small glands located on either side of the vaginal opening. These glands are responsible for producing lubricating fluid that helps to moisten the vaginal area. When one of these glands becomes blocked due to infection or trauma, it can lead to the formation of a cyst. 

The symptoms may include dyspareunia, urinary irritation, and pelvic pain. These cysts can be diagnosed through a physical examination. Small, asymptomatic cysts may not require treatment and can resolve on their own. 

The treatment options include warm sitz baths, drainage of the cyst or abscess, and sometimes surgical procedures to create a permanent duct (marsupialisation) to prevent future cysts. If an infected Bartholin's cyst is not treated, it can develop into a more severe infection called a Bartholin's abscess. This can cause significant pain, and fever, and may require drainage and antibiotic treatment.⁶

Müllerian cysts

Müllerian cysts are found in the broad ligament, a band of connective tissue that supports the uterus, or in the tissue around the fallopian tubes. These cysts are usually benign (non-cancerous) and are often small and do not show any symptoms.

However, if Müllerian cysts become large or cause symptoms, they can lead to pelvic pain, discomfort, or pressure in the lower abdomen. In some cases, they may interfere with the normal functioning of nearby organs or structures, such as the fallopian tubes or ovaries.

The diagnosis of these types of cysts can be done using ultrasonography, MRI, and histopathology. Small cysts do not require any treatment but large cysts need surgical treatment.⁷

Diagnosis of vaginal cysts

There are several types of vaginal cysts, and the diagnostic approach may vary depending on the specific characteristics and symptoms. Here are some common diagnostic options for vaginal cysts:

Medical history

Your healthcare provider will start by taking a detailed medical history, which may include questions about your symptoms, any previous vaginal issues, sexual history, and family history of cysts or related conditions.⁶

Physical examination

A pelvic examination is performed to determine the size, location, and characteristics of the vaginal cyst.⁶ 

Ultrasound

In some cases, a transvaginal ultrasound may be recommended. This imaging technique uses sound waves to create images of the pelvic area, helping to confirm the presence of a cyst, determine its size, and assess its characteristics.⁴

Magnetic resonance imaging (MRI)

If the cyst is difficult to analyse with ultrasound, an MRI may be performed to provide more detailed images and help with diagnosis.²

Biopsy

In some cases, a tissue sample (biopsy) may be taken from the cyst for further evaluation. This is typically done if there is uncertainty about the nature of the cyst or if it appears suspicious.⁶

Laboratory tests

Blood tests may be performed to assess hormonal levels, particularly if the cyst is thought to be related to hormonal changes.³

Differential diagnosis

This step involves differentiating vaginal cysts from other conditions that may present with similar symptoms or findings, such as Bartholin's gland cysts or Gartner's duct cysts. A thorough evaluation helps differentiate between these possibilities. The patient's history, physical examination findings, and imaging results may be used to rule out other potential conditions.⁶

Cyst aspiration

In some cases, if the cyst is large and causing symptoms, your healthcare provider may recommend draining the cyst through a procedure called cyst aspiration. The fluid obtained can be sent for analysis to confirm the diagnosis.⁷

Treatment of vaginal cysts

The treatment options for vaginal cysts depend on their size, location, and symptoms. Here are some common treatment options for vaginal cysts:

Observation

Small, asymptomatic cysts may not require any treatment and can be monitored over time to ensure they do not grow or cause any problems.⁷

Sitz baths

Vaginal sitz baths are a therapeutic practice where a person sits in warm, shallow water to alleviate discomfort or promote healing in the vaginal area. It involves soaking the lower pelvic region in a specially designed basin or tub for a specified duration. For certain types of vaginal cysts, such as Bartholin's cysts, warm sitz baths can help alleviate discomfort and promote drainage.⁶

Antibiotics

If a cyst becomes infected, your healthcare provider may prescribe antibiotics to treat the infection.⁶

Incision and drainage

For cysts that are painful or infected, a healthcare provider may perform a minor surgical procedure to drain the cyst and relieve symptoms.⁶

Marsupialization

This surgical procedure involves creating a permanent opening in the cyst to allow it to drain continuously, reducing the risk of recurrence. It is commonly used for Bartholin's cysts.⁶

Excision

Larger or recurrent cysts may require surgical removal (excision). This is typically done when other treatments have failed or when the cyst is causing significant discomfort or pain.⁷

Laser therapy

In some cases, laser therapy may be used to remove or treat vaginal cysts, particularly if they are small or located in a specific area.⁶

Biopsy

In some cases, a biopsy may be necessary to rule out more serious conditions, such as cancer, if the cyst looks suspicious or if it doesn't respond to other treatments.⁶

FAQ

Do vaginal cysts go away?

Vaginal cysts can sometimes resolve on their own, but it depends on the type and cause. Small, benign cysts may disappear without treatment, while others may require medical intervention such as drainage or surgical removal. Consult a healthcare provider for proper evaluation and guidance on managing vaginal cysts.

How long can a vaginal cyst last?

The duration of a vaginal cyst can vary widely depending on its type and underlying cause. Some small, simple cysts may resolve on their own within a few weeks to months, while others may persist indefinitely without treatment. It's crucial to consult a healthcare provider for an accurate diagnosis and appropriate management, as some cysts may require medical intervention or removal.

Can a vaginal cyst become cancerous?

While most vaginal cysts are benign, there is a rare possibility that certain types, like Bartholin's gland cysts, may develop into cancer. However, this is exceptionally rare. Regular medical check-ups and prompt evaluation of any unusual vaginal lumps are essential to rule out any potential malignancy and ensure timely treatment if needed.

Summary

A vaginal cyst is a gynaecological condition characterized by the formation of a small, fluid-filled sac or lump within the vaginal wall. These cysts typically develop due to blockages in the vaginal glands or the accumulation of fluid or mucus, and they are usually non-cancerous.

Vaginal cysts can vary in size and may not always cause noticeable symptoms. However, when symptoms do occur, they can include discomfort or pain. 

Diagnosis of vaginal cysts often involves a pelvic examination by a healthcare provider, along with imaging tests like ultrasound to confirm the presence and size of the cyst. Treatment options for vaginal cysts depend on their size, location, and symptoms. Small, asymptomatic cysts may not require treatment and can be monitored over time. If necessary, larger or symptomatic cysts can be drained or surgically removed.