What are Vaginal Cysts and Lesions?
Benign Vaginal Cysts and 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. Benign cystic lesions of the vagina may present a wide spectrum, from small asymptomatic lesions to cysts large enough to cause urinary obstruction.
Although most cases of vaginal lesions are benign, it’s important to follow up with your health care doctor about these conditions. 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. Medical history, pelvic exam, and radiological imaging, such as magnetic resonance imaging, are useful in diagnosis.
Symptoms of Benign Vaginal Cysts and 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 Benign Vaginal Cysts and Lesions in the advanced stages include:
- Feeling of pressure
- Painful sexual intercourse
- An obstruction in the urethra or vagina
- Abnormal vaginal bleeding
- Vaginal discharge
Types of Vaginal Cysts
In the lower female genital tract, the differential diagnoses of a cyst include:
Vaginal Inclusion Cyst or Epidermal Inclusion Cyst
The most common type of cyst is the vaginal inclusion cyst, or an epithelial inclusion cyst is also referred to as epidermal inclusion cyst or squamous epithelium inclusion cyst. This type of cyst comprises 23% of all vaginal cysts and is very common. This cyst originates from epithelium tissue that has been “trapped” from surgery, episiotomy, or other trauma. It is most often found on the lower posterior vaginal wall. An epidermoid cyst is one type of vaginal cyst. Inclusion cysts are small and located on the posterior, lower end of the vagina.
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 Gartner’s duct, fluid may build up and form a Gartner duct cyst as the child ages.
Bartholin’s Gland Cyst
The Bartholin’s gland (at times, Bartholin cyst) is located near the side of the vaginal opening on vaginal lips (labia). If a flap of skin grows over this gland, fluid can back up into the Bartholin gland and form a cyst. This cyst is usually painless. If the cyst becomes infected, it can become an abscess.
Paramesonephric Cyst or Müllerian Cysts
Like the Gartner’s duct, the paramesonephric ducts (or Müllerian duct cysts) 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 Benign Tumors
These are smooth muscle neoplasms that appear on the anterior (front) vaginal wall. They are usually benign, asymptomatic, and exceedingly rare.
These polyps are usually small and sometimes grow in clusters. If the polyps are small and aren’t causing any symptoms, then 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 and create complications.
This is the medical term for the lesions caused by HPV (human papillomavirus). There are various treatments available for removing the lesions, including surgical excision (surgical removal), 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.
Considered the most common type of lesion, the urethral caruncle is found in the female urethra and typically occurs in postmenopausal women. 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.
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.