Treatment of Inclusion Cyst on the Labia
Surgical excision is the definitive treatment for labial inclusion cysts that are symptomatic or enlarging, while asymptomatic small cysts can be managed conservatively with observation. 1
Understanding Inclusion Cysts of the Labia
Inclusion cysts on the labia are benign lesions that form when epithelial cells become trapped beneath the skin surface. They typically present as:
- Smooth, round, firm nodules under the skin
- Usually painless unless infected or large enough to cause discomfort
- May gradually increase in size over time
Management Algorithm
Conservative Management
For small, asymptomatic cysts (<3 cm):
- Observation with routine follow-up
- No specific intervention required
- Patient education about signs that would warrant reassessment (growth, pain, redness)
Indications for Surgical Intervention
Surgical excision is recommended when the cyst:
- Causes discomfort or pain
- Interferes with sexual activity
- Shows signs of infection
- Continues to enlarge
- Causes cosmetic concerns important to the patient
Surgical Approach
Complete surgical excision is the treatment of choice for symptomatic or enlarging labial inclusion cysts 2, 3:
- Simple excision under local anesthesia for smaller cysts
- Complete removal of the cyst wall to prevent recurrence
- Careful dissection to avoid damage to surrounding tissues
Special Considerations
Differential Diagnosis
Before proceeding with treatment, it's important to distinguish inclusion cysts from other vulvar lesions:
- Bartholin's gland cysts (located specifically at the vaginal opening)
- Sebaceous cysts
- Hidradenoma papilliferum
- Peritoneal inclusion cysts (which are intra-abdominal) 4
Potential Complications
- Infection: May require antibiotics before surgical intervention
- Recurrence: More likely if cyst wall is incompletely excised
- Scarring: Usually minimal with proper surgical technique
Follow-up Care
After surgical excision:
- Keep the area clean and dry
- Monitor for signs of infection
- Follow up if there are concerns about wound healing or recurrence
Clinical Pearls
- Inclusion cysts of the labia are generally benign and have no malignant potential, unlike some other cystic lesions 1
- Avoid incision and drainage alone as this typically leads to recurrence
- Histopathologic examination of excised tissue is recommended to confirm diagnosis 5
- Clitoral inclusion cysts may require more specialized surgical approach to preserve sensation and function 5
While guidelines for ovarian and adnexal cysts are well established 1, specific guidelines for labial inclusion cysts are less formalized, but the principles of management follow similar patterns of observation for asymptomatic lesions and excision for symptomatic or enlarging ones.