Operative gynecology - (1906) (14781201664)

Vaginal cysts are uncommon

benign Malignancy () is the tendency of a medical condition to become progressively worse. Malignancy is most familiar as a characterization of cancer. A ''malignant'' tumor contrasts with a non-cancerous benign tumor, ''benign'' tumor in that a malign ...

cyst A cyst is a closed sac, having a distinct envelope and cell division, division compared with the nearby Biological tissue, tissue. Hence, it is a cluster of Cell (biology), cells that have grouped together to form a sac (like the manner in which ...

s that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine

pelvic examination A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, dis ...

. Vaginal cysts can mimic other structures that protrude from the vagina such as a

rectocele In gynecology, a rectocele ( ) or posterior vaginal wall prolapse results when the rectum bulges ( herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pe ...

and cystocele. Some cysts can be distinguished visually but most will need a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be

palpated Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...

(felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include

cancers Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Poss ...

and

tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.

Types

Vaginal inclusion cysts can appear as small bumps and can develop during childbirth, or after surgery. A squamous inclusion cyst can rarely be found in a newborn. Other cysts can be

Bartholin's cyst A Bartholin's cyst occurs when a Bartholin's gland within the labia becomes blocked. Small cysts may result in minimal or no symptoms. Larger cysts may result in swelling on one side of the vagina, as well as pain during sex or walking. If the cys ...

Gartner's duct cyst A Gartner's duct cyst (sometimes incorrectly referred to as ''vaginal inclusion cyst'') is a benign vaginal cyst that originates from the Gartner's duct, which is a vestigial remnant of the mesonephric duct (wolffian duct) in females. They are typi ...

s, mucous inclusions, epithelial inclusion cysts,

embryonic cysts Embryonic may refer to: *Of or relating to an embryo * ''Embryonic'' (album), a 2009 studio album by the Flaming Lips *'' Embryonics'', a 2005 album by Alchemist {{Disambiguation ...

and urothelial cysts. Less common vaginal cysts are endometrial cysts and vaginitis emphysematosa. Vaginitis emphysematosum is a group of gas-filled cysts on the vaginal wall; these are benign and self-limiting (resolve on their own). Vaginal cysts can also be congenital and associated with urinary system anomalies The most common type of vaginal cyst are Müllerian cysts. These usually develop on the anterolateral vaginal wall. This cyst can be lined with epithelium from the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

and

Fallopian tubes The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...

. An epithelial inclusion cyst is also referred to as epidermal inclusion cyst or squamous inclusion cyst. This type of cyst comprises 23% of all vaginal cysts and is the second most common. This cyst originates from epithelium tissue that has been 'trapped' from

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...

, or other trauma. It is most often found on the lower posterior vaginal wall. An

epidermoid cyst An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium. Signs and symptoms The epidermoid cyst may ...

is one type of

vaginal cyst Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is ...

. Inclusion cysts are small and located on the posterior, lower end of the vagina. Small pieces of vaginal epithelium are trapped beneath the surface due to perineal lacerations and imperfect surgical repair after an episiotomy. A

develops from a small tissue remnant of the

mesonephric duct The mesonephric duct (also known as the Wolffian duct, archinephric duct, Leydig's duct or nephric duct) is a paired Organ (anatomy), organ that forms during the embryonic development of humans and other mammals and gives rise to male Sex organ, r ...

. Symptoms include:

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

, bladder dysfunction,

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

vaginal discharge Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amou ...

, and

urinary incontinence Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...

. It is often large enough to cause urinary incontinence but surgical removal provides treatment and recurrence is unlikely. Diagnosis is confirmed with

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

imaging. The evaluation by biopsy provides the most accurate diagnosis. This cyst has a lining of epithelial tissue that varies from squamous to mucin-secreting transitional epithelium. Occasionally, a parasitic infection causes a vaginal cyst.

Signs and symptoms

In most instances, symptoms are minimal or absent. Some women may experience vaginal pressure, discomfort, swelling, painful sex, or bleeding. Cysts can also be sensitive and tender to the touch.

Diagnosis

Diagnosis is aided by the use of ultrasound, CT scan, voiding cystourethrogram, and MRI. Ultrasound findings may be the visualization of smooth margins of a fluid-filled structure. Vaginal cysts resemble other structures that protrude from the vagina such as rectocele and cystocele. Histological assessment is needed to determine the specific type of cyst. Vaginal cysts are often discovered during a routine pelvic exam or pap smear. Cysts are also discovered during a bimanual exam. Other structures that resemble vaginal cysts are connective tissue tumors, hematocolpos, and hymenal atresia. The absence of

vaginal rugae Vaginal rugae are structures of the vagina that are transverse ridges formed out of the supporting tissues and vaginal epithelium in females. Some conditions can cause the disappearance of vaginal rugae and are usually associated with childbirth an ...

over the cyst is a clue to their presence.

Treatment

Many cysts remain small, are followed closely by a clinician, and resolve on their own. Surgery and/or drainage is performed to remove the cyst. Treatment continues after the surgical removal by scheduled followups with the medical provider who looks for changes in the cyst. Bartholin gland cysts often need to be drained. Sometimes, antibiotics are prescribed to treat them as well. Treatment for these usually includes aspiration, marsupialisation and deroofing. When cysts are treated complications are few. Vaginal cysts rarely recur. When surgically removed, the cysts usually do not return. In some cases a Bartholin cyst can develop and need further treatment. In most cases, there are no complications from the cysts themselves. A surgical removal carries a small risk of complication. The risk depends on where the cyst is located.

References

External links