Vulvar and Vaginal Cysts are generally harmless, but have the potential to be troublesome at times.
Cystic lesions of the vulva and vagina are not very serious in nature but are a problem for female patients. Vulva forms the lower reproductive tract in women. It comprises of the labia-majora and minora, clitoris, urinary meatus, vaginal orifice, hymen, Bartholin’s gland & Skene ducts. The skin here is delicate having large numbers of sebaceous glands, but few sweat glands. Vagina is the lower opening of the cervical canal. A cyst is a sac like structure filled with fluid, pus, air or blood.
Types of vulvar and vaginal cysts
Bartholin’s cyst: Bartholin’s glands are present in the labia and open into the vagina, secreting mucus to keep the vulva moist. Occlusion of the duct lumen leads to collection of the secretions and formation of a cyst. It is a common occurrence in women, though it is rare post-menopause. The cause of cyst formation is not known, but the size and rate of growth are related to hormones and sexual stimulation. Some relation to gonorrhea, chlamydia and other bacterial infection is seen. Usually cysts are tiny and asymptomatic, but can cause discomfort if they increase in size. Asymptomatic cysts usually subside with time. Recurrent cysts in menopausal women may be excised due to increased risk of carcinoma of Bartholin’s gland.
Skene Gland cyst: These are tiny glands adjacent to the urethral meatus. They secrete fluid to lubricate the vagina. A cyst formed in this gland is situated near the urinary meatus cannot be felt and does not cause any problem. If it is large in size it may cause pain and urinary obstruction. Treatment is indicated only if it is symptomatic and excision is to be done after infection subsides.
Epidermal inclusion cyst: These are most common of the vulvar cysts. They are caused due to the blockage of the sebaceous glands. They may also be multiple. They are firm non-tender nodules felt under the skin, generally causing no symptoms, hence requiring no treatment. If it is large in size but not infected, they can be removed by wide excision or by a punch biopsy to remove the contents. Inclusion cysts in the vagina are usually seen at the site of a previous surgery e.g. an episiotomy or due to trauma. They can be felt as round masses felt protruding through the vagina causing no problem. They need not be evaluated further unless infected.
Gartner Duct cyst: These are uncommon vaginal cysts, developing from remnants of the mesonephric duct. They are asymptomatic and usually discovered as a bulge on the lateral vaginal wall during routine examination. They may cause vaginal pain, problem during sexual intercourse or obstruction while inserting tampons etc.
Other vulvar and vaginal cysts are seen along with some skin conditions. Endometriosis may also be seen as blue or red colored firm cystic nodules.
Most of these cysts are asymptomatic and heal on their own. Some measures for prevention are to keep the area clean and dry. Sitting in a basin of hot water for 10-15 minutes provides relief. If the cyst gets infected or abscess formation occurs, then incision and drainage is to be done along with a course of oral antibiotics. Large or persistent cysts may require marsupialization (surgical excision).
Photograph via sxc.hu
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