What is the treatment for Nabothian (Nabothian gland) cysts?

Treatment of Nabothian Cysts

Most Nabothian cysts require no treatment, as they are benign cervical retention cysts that are typically asymptomatic and clinically insignificant. 1, 2, 3

When No Treatment is Needed

• Small, asymptomatic Nabothian cysts (the vast majority) require no intervention or follow-up. 3, 4 These are common benign findings in women of reproductive age that form when cervical mucus accumulates in blocked cervical crypts. 3

• Routine surveillance imaging is not indicated for typical small Nabothian cysts identified incidentally. 2

When Intervention May Be Required

Large or Symptomatic Cysts

• Cysts larger than 4 cm are extremely rare and may require intervention if they cause symptoms such as dyspareunia, pelvic pain, or mechanical obstruction. 3, 4

• Symptoms warranting treatment include:

  • Chronic pelvic pain or dyspareunia 3
  • Vaginal mass sensation or protrusion 1
  • Obstruction of labor passage (rare obstetric emergency) 4
  • Urinary or bowel symptoms from mass effect 1

Diagnostic Uncertainty

• When imaging cannot definitively distinguish a large Nabothian cyst from adenoma malignum (a rare mucinous cervical adenocarcinoma), excision with histopathologic confirmation is necessary. 2, 3 This is a critical diagnostic challenge, as both can present as multilocular cervical cystic masses.

• Preoperative imaging with both ultrasound and MRI is recommended for large cervical cystic masses to characterize the lesion and plan surgical approach. 3, 5

Treatment Options When Intervention is Needed

Minimally Invasive Approaches (Preferred)

• Laparoscopic excision is the preferred surgical approach for large symptomatic Nabothian cysts, allowing complete removal while avoiding unnecessary hysterectomy. 3, 5 This provides tissue for definitive histopathologic diagnosis and preserves fertility when desired.

• Simple aspiration/drainage can be performed as a temporizing measure in urgent situations (such as obstructing labor), though cysts may recur without complete excision. 4

More Extensive Surgery

• Total excision of the cyst is recommended when the diagnosis needs histopathologic confirmation or when simple drainage fails. 4

• Hysterectomy should be reserved for cases where:

  • The patient has completed childbearing and desires definitive treatment 1
  • There are coexisting gynecologic conditions requiring hysterectomy 1, 5
  • Malignancy cannot be excluded preoperatively and the patient is not a candidate for fertility preservation 2

Important Clinical Pitfalls

• Do not assume all large cervical cystic masses are benign—adenoma malignum can mimic Nabothian cysts on imaging and examination. 2, 3 Histopathologic confirmation is essential for masses larger than 4 cm or those with atypical features.

• Be aware that large Nabothian cysts can unmask underlying pelvic organ prolapse by increasing downward pressure, which may persist after cyst removal and require separate management. 1

• During laparoscopic surgery for large cervical cysts, anticipate technical challenges including difficult bladder dissection, ureteric identification, and vault delineation due to distorted anatomy. 5