What are vaginal cysts?

Vaginal Cysts: Types, Diagnosis, and Management

Vaginal cysts are benign, predominantly cystic lesions that occur in the vaginal wall with a prevalence of approximately 1 in 200 women. 1 These cysts can vary in size from small asymptomatic lesions to large masses that may present as symptomatic genital prolapse.

Types of Vaginal Cysts

Vaginal cysts can be classified based on their embryological origin:

1. Müllerian cysts:

   • Can be found at any location in the vagina
   • Lined with endocervical-type columnar epithelium
   • Form when Müllerian epithelium persists along the vaginal wall 2

2. Gartner's duct cysts (mesonephric):

   • Typically found on the anterolateral vaginal wall
   • Remnants of the mesonephric (Wolffian) ducts 2

3. Other types:

   • Skene duct cysts
   • Bartholin gland cysts
   • Epidermal inclusion cysts
   • Endometriotic cysts 2

Clinical Presentation

• Most vaginal cysts are solitary, small, and asymptomatic 1
• Larger cysts may present with:
  • Vaginal bulging or protrusion
  • Pelvic pressure
  • Dyspareunia
  • Urinary symptoms (in cases where cysts compress the urethra) 3
• Large cysts can be misdiagnosed as cystocele or pelvic organ prolapse 1

Diagnostic Approach

1. Physical examination:

   • Essential for detection and characterization of vaginal cysts
   • Can identify location, size, and consistency of the cyst 4

2. Imaging studies:

   • Magnetic Resonance Imaging (MRI): Useful for localizing and differentiating vaginal cysts from other conditions such as urethral diverticulum 4
   • Translabial ultrasound: Can help determine if the cyst has any connection to surrounding structures 2
   • Voiding cystourethrogram: May be useful in cases where urological abnormalities are suspected 3

Management

For symptomatic vaginal cysts, complete surgical excision via vaginal approach is the recommended management with good anatomical results and patient satisfaction. 1

• Asymptomatic small cysts: Generally require no intervention 5
• Symptomatic cysts: Surgical excision is indicated when cysts cause:
  • Pain or discomfort
  • Urinary symptoms
  • Sexual dysfunction
  • Cosmetic concerns 3

Surgical Considerations

• Meticulous dissection is important, especially when the cyst is adjacent to the bladder or urethra 2
• Follow-up at 6 weeks and 6 months post-surgery is recommended to monitor for recurrence 1
• Recurrence rates are generally low following complete excision

Special Considerations

• Cysts in women over 40 years of age should receive special attention to rule out malignancy 5
• Fixed cysts or those associated with pain or bleeding warrant further investigation 5
• Understanding the exact location and relationship to surrounding structures is crucial for surgical planning and patient counseling 2

Vaginal cysts represent a spectrum of benign conditions that are relatively common but often underdiagnosed. While most are asymptomatic and require no intervention, symptomatic cysts benefit from surgical excision with excellent outcomes and minimal recurrence risk.