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What are Benign Vulvar Lesions?
Benign Vulvar Lesions, or neoplasms, of the vagina, are fairly rare. There are two main categories of vaginal neoplasms – cystic tumors and solid lesions, as well as a few related conditions that will be discussed here briefly. The type of lesion can usually be diagnosed with a pelvic exam and a biopsy.
Although most cases of vaginal lesions are benign, it’s important to follow up with your doctor. Typically, your OB-GYN will want to take a biopsy or perform other tests to check for any precancerous cell changes. Mild cases may not require treatment, but lesions that are causing you problems or those that may become malignant require surgical or nonsurgical removal.
Symptoms of Benign Lesions
In most cases, vaginal tumors result in no symptoms at all until they have grown to a significant size. When no symptoms are present, they are usually detected during a routine pelvic exam.
However, some common symptoms of lesions in the advanced stages include:
- Feeling of pressure
- Painful sexual intercourse
- An obstruction in the urethra or vagina
- Abnormal vaginal bleeding
Cystic Tumors
Vaginal Inclusion Cyst
The most common type of cyst is the vaginal inclusion cyst, which typically develops after a vaginal injury, such as an episiotomy or injury during childbirth or a surgical procedure.
Endometriosis
This is a condition in which the endometrium – the tissue that normally lines the inside of the uterus – begins to grow on other organs outside the uterus. Endometriosis of the vagina may result in the appearance of small cysts.
Gartner’s Duct Cyst
The Gartner’s duct is a duct that is usually only present in a fetus’s genitals in utero, and in most cases, the duct disappears before birth. If the baby’s body does not completely absorb the duct, fluid may build up and form a cyst as the child ages.
Paramesonephric Cyst
Like the Gartner’s duct, the paramesonephric ducts (or Mullerian ducts) aid in the development of the fetal reproductive system. In female babies, these ducts will eventually form the uterus, fallopian tubes, cervix, and top of the vagina. These ducts, too, can become cystic in adults.
Solid Tumors
Leiomyoma
These are smooth muscle neoplasms that appear on the anterior (front) vaginal wall. They are usually benign, asymptomatic, and exceedingly rare.
Fibroepithelial Polyps
These polyps are usually small and sometimes grow in clusters. If they are small and don’t cause any symptoms, they don’t require treatment. However, women who plan on becoming pregnant may want to have them surgically excised, as they can become enlarged during pregnancy.
Condyloma Acuminatum
This is the medical term for the lesions caused by HPV (human papillomavirus). Various treatments are available for removing the lesions, including surgical excision, loop electrical excision, laser therapy, or cauterization. However, your doctor may recommend treating the lesions conservatively, as any of these procedures may result in vaginal scarring.
Related Conditions
Urethral Caruncle
This is the most common type of lesion found in the female urethra and typically occurs in postmenopausal patients. The lesions can usually be treated at home with warm sitz baths or with the help of vaginal estrogen replacement therapy, such as a prescription vaginal cream.
Diethylstilbestrol (DES) Associated Changes of the Vagina
DES is a synthetic substitute for the hormone estrogen that was sometimes prescribed to pregnant women in the 1940s, 50s, 60s, and early 70s. However, doctors stopped prescribing it when it was found to be linked to cervical and vaginal cancer. An estimated 1 out of 1000 women treated with DES will develop adenocarcinoma of the cervix or vagina. If you received DES therapy, you should discuss your concerns with your gynecologist and schedule routine exams.
Suburethral Diverticulum
A urethral or suburethral diverticulum is a small protruding pouch of urethral tissue into the vaginal space. Patients with this condition often complain of recurrent urinary tract infections, urinary frequency, burning with urination, and painful intercourse. Since these symptoms can be related to other urinary conditions, it is important to be evaluated by a physician to get a proper diagnosis.
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Sources
Contact sensitivity in vulva lichen simplex chronicus – Virgili – 1997 – Contact Dermatitis – Wiley Online Library
https://doi.org/10.1111%2Fj.1600-0536.1997.tb02469.x
Sze S, Richmond I, Bickers A, Saha A. Squamous cell carcinoma arising from a vulval epidermal cyst. J Obstet Gynaecol Res. 2016; 42 (11):1623–1626.
https://pubmed.ncbi.nlm.nih.gov/27785896/
