Vaginal Cyst

A cyst is a closed pocket or pouch of tissue. It can be filled with air, fluid, pus, or other material. A vaginal cyst is a closed sac on or under the vaginal lining.

Causes, incidence, and risk factors

There are several types of vaginal cysts.

• Vaginal inclusion cysts are the most common. These may form as a result of injury to the vaginal walls during birth process or after surgery.
• Gartner’s duct cysts develop on the side walls of the vagina. This duct is present while a baby is developing in the womb but will most often disappear after birth. If parts of the duct remain, they may collect fluid and develop into a vaginal wall cyst later in life.
• Bartholin’s cyst or abscess is the buildup of fluid for pus that forms a lump in one of the glands found on each side of the vaginal opening.
• Pieces of endometriosis may appear as small cysts in the vagina.
• Benign tumors of the vagina are uncommon and are usually made up of cysts.

Symptoms

Vaginal cysts usually do not cause symptoms, although there may be a soft lump felt in the vaginal wall or protruding from the vagina. Cysts range in size from the size of a pea to that of an orange. Some women with vaginal cysts may have discomfort during sex or trouble inserting a tampon.

Signs and tests

Upon pelvic examination, a mass or bulge of the vaginal wall may be seen or felt by the examiner. A biopsy may be necessary to rule out vaginal cancer, especially if the mass appears to be solid. If the cyst is located under the bladder or urethra, X-rays may be required to be sure the cyst does not involve these structures.

Treatment

The only treatment needed may simply involve routine exams and watching the cyst for growth and other changes. Opening and draining the cyst does not usually work well and may lead to infection. Surgery may be needed if the cyst is causing symptoms. However, this can sometimes be a very involved surgery and is not recommended unless you are having more severe symptoms.

Complications

There are usually no complications from the cysts themselves. A surgical excision procedure carries a small risk of complications depending on where the cyst is located in relation to other structures.

Bartholin’s Cyst

The Bartholin’s glands are located at the entrance to a woman’s vagina, one on each side. They are small and cannot be seen or felt when they are normal. Their function is to secrete fluid onto the mucosal (inner) surface of the labia-the liplike skin surrounding the vagina. Problems with the Bartholin’s glands include cysts, which are relatively painless enlargements of the gland, and abscesses, which are infections of the gland. Typically only 1 of the 2 glands is affected.

Bartholin’s Cyst Causes

A Bartholin’s cyst develops when the duct exiting the Bartholin’s gland becomes blocked. The fluid produced by the gland then accumulates, causing the gland to swell and form a cyst. An abscess occurs when a cyst becomes infected. Bartholin’s abscesses can be caused by any of a number of bacteria. These include bacterial organisms that cause sexually transmitted diseases such as chlamydia and gonorrhea as well as bacteria normally found in the intestinal tract, such as Escherichia coli. It is common for these abscesses to involve more than one type of organism.

Bartholin’s Cyst Symptoms

A Bartholin’s cyst causes swelling of the labia on one side, near the entrance to the vagina. A cyst is usually not very painful, and significant pain suggests that an abscess has developed. However, large cysts may be painful simply by virtue of their size. A Bartholin’s abscess causes significant pain in addition to the swelling. The swollen area is extremely tender and the skin reddened. Walking and sitting may be quite painful. Women with Bartholin’s abscesses do not usually have fever. Vaginal discharge may be present, especially if the infection is caused by a sexually transmitted organism.

With Bartholin’s cysts and abscesses, the primary reason to seek emergency care is acute pain. Women who are experiencing severe pain or who cannot sit or walk comfortably should see a doctor as soon as possible.

Treatment for Bartholin’s Cysts and Abscesses

Treatment is not always needed

If you have a small cyst that causes no symptoms, and does not become infected, then it may be best simply to leave it alone. However, always report a ‘lump’ in the area around your vagina (your vulva) to your doctor. Do not just assume a small lump is a Bartholin’s cyst. It is best for a doctor to examine you to confirm the diagnosis and to rule out other causes of lumps in the vulva. If a cyst causes symptoms, then it can be treated. A Bartholin’s abscess will almost always need treatment as it can be very painful. However, if an abscess is left long enough it is likely to burst and then may resolve without treatment. This is not recommended though as it will be very painful and you could become quite ill.

Antibiotics for an infection or abscess

A course of antibiotics has a good chance of curing an infected gland or abscess. However, as a rule, the more pus that forms, the larger the abscess, and the less chance that antibiotics alone will be sufficient to clear the abscess without also needing to drain the pus.

Surgery for Bartholin’s Cyst or Abscess

The main aim of the operation is to drain any fluid or pus. This relieves symptoms. But also, another aim is to minimise the chance of the problem recurring.

Marsupialisation

A small operation called marsupialisation is the traditional treatment used to treat a Bartholin’s cyst or abscess. A small cut (incision) is made into the cyst or abscess just inside the entrance to the vagina. Any fluid or pus drains out. The cut is widened to about 1 cm. A few stitches are then used to to stitch the inside lining of the cyst to the overlying skin. This then creates a small new permanent opening for fluid to drain out of the gland. Initially, the opening that is left is like a pouch – hence the name of the operation. However, the opening gradually becomes smaller and soon the opening becomes tiny and not noticeable. But this new opening is, in effect, like a new duct which allows any fluid that is made by the gland to drain. A course of antibiotics may be prescribed if pus is drained from an abscess. However, antibiotics are not always needed once the pus has been drained. Marsupialisation is usually successful. In only a few cases does the problem recur if this procedure is done. If a simple cut is made to drain the fluid or pus without then doing a marsupialisation, there is a higher chance that the problem will recur at some point. As with all operations there is a small chance of problems. For example, infection of the wound occurs in a small number of cases following marsupialisation.

Sometimes the entire gland is removed by a surgical operation. This is considered a ‘last resort’ but may be advised if you have several recurrences of a Bartholin’s cyst or abscess.

Prevention of Bartholin’s cysts or Abscesses

It is not usually possible to prevent a Bartholin’s Cyst or Abscess. Most occur ‘out of the blue’ for no apparent reason. Some Bartholin’s abscesses are due to sexually transmitted infections, and so using a condom when having sex may prevent some cases. As mentioned, some people say that, if a cyst develops, then sitting in warm baths may possibly help it to burst and prevent a possible abscess from developing.