Vaginal Cysts: Causes & Treatment

Cysts can be defined as sac like structures that can develop in any part of the body. These structures can be filled with air or fluid. Cysts very rarely cause any pain and are not a source of any harmful event that may occur in the body. The size of a cyst is variable and ranges from very small to the size of a golf ball. When cysts develop in the vagina then it is referred to as vaginal cysts. There can be many causes for a vaginal cyst ranging from a trauma or injury or as a result of delivery of a child. Accumulation of fluid also is one of the primary causes of development of cysts ^[2].

Studies were conducted to define the pathological features of vaginal cysts. For this, a detailed analysis was carried out of cases of vaginal cysts over a period of five years. The clinical findings were correlated with the case reports of all the patients and laboratory findings. The results of the data analyzed in which 40 cases were reviewed of vaginal cysts. Among these cases, 30% were identified to be Mullerian cysts and 28% were Bartholin cyst. Another 25% were found to be inclusion cysts, and only 2% did not have a clear cut type. All the different types of vaginal cysts have been explained in detail in the article below ^[1].

The age of the patients ranged from 20 to 70 years and the average age of the patient at the onset of symptoms was found to be between the third and fourth decade of life. In about 80% of the cases, there were no symptoms observed and even if symptoms were observed they were more related to Bartholin duct cysts. The location of the cyst was in majority of the cases along the left lateral wall of the vagina. The study concluded that majority of vaginal cysts did not have any symptoms and their diagnosis was made incidentally when the area was being evaluated for some other reason ^[1].

The pathogenesis of most of the types of vaginal cysts still requires further research to be completely clarified. Explained in greater detail are the causes and treatment options for vaginal cysts ^[1].

Before explaining the causes of vaginal cysts, it is important to have knowledge of the different types of vaginal cysts. While some cysts are caused as a result of an injury to the vagina during delivery of a child, in some cases surgical procedures also cause trauma or injury leading to development of vaginal cysts.

Vaginal cysts are classified as ^[2]:

Bartholin Gland Cysts: The development of this type of vaginal cyst occurs in the Bartholin gland which is located on either side of the vaginal opening. These cysts are filled with fluid. The function of this gland is to lubricate the vagina and makes it ready for sexual intercourse ^[2].

Inclusion Cysts: These types of vaginal cysts develop on the back portion of the vaginal wall. These cysts are extremely small and cannot be easily noticed. This is the most common type of cyst that develops in the vagina. Injury due to surgery or childbirth is the primary cause of the development of inclusion vaginal cysts ^[2].

Müllerian Cysts: This type of vaginal cyst is also quite common. This develops as a result of the debris left behind during the development of the fetus after the delivery of the child. They can develop anywhere along the walls of the vagina and are filled with mucous ^[2].

Gartner Duct Cysts: These cysts develop when the ducts which normally close after a baby is born remain open. With the passage of time, these ducts turn into vaginal cyst ^[2].

A cyst in majority of the cases occurs when a gland or a duct gets clogged due to debris. This results in accumulation of fluid and other waste material around the gland causing cysts to develop. The area where the cysts occur and the features of the cysts determine what type of cyst it is. As an example, if a cyst is caused due to an injury to the vaginal area then it is termed as an inclusion cyst ^[2].

Injury is the primary risk factor for development of vaginal cysts. This may occur mainly during delivery of a baby when the lining of the vagina may stretch excessively when the baby is coming out and may tear causing cysts to develop. It may also happen as a result of a surgical trauma where the vaginal walls may get injured causing a cyst to develop ^[2].

At times, a small surgical procedure called episiotomy in which an opening is made between the anus and the vagina during delivery of a child to increase the vaginal opening also can cause cysts to develop. Bartholin cyst occurs when this gland gets blocked by a skin flap which actually functions by protecting and covering it ^[2].

The primary complication that arises due to vaginal cyst is the development of an infection which results in abscess formation. Abscess is defined as collection of pus and fluid which causes erythema, pain, and swelling. An abscess is something almost always needs drainage for treatment. Abscess due to vaginal cysts are normally caused when the cyst gets infected with a sexually transmitted infection like chlamydia and gonorrhea ^[2].

In case if a female notices a lump on the vagina which may be growing in size then it is important to consult with a physician to ensure that the abnormal growth is a benign cyst or something more sinister is developing. A consultation with a physician is also recommended if the vaginal cysts gets painful, red, or starts to drain pus as this may be a sign of an infection ^[2].

In majority of the cases Vaginal Cysts do not need treatment. However, if a female experiences pain, redness, and discomfort then it may be a sign of an abscess or an infection which will require treatment. The primary mode of treatment of vaginal cysts that gets infected include ^[2]:

Antibiotics: These are usually given for females who have a sexually transmitted infection. Additionally, if the vaginal cysts go on to develop into an abscess then drainage of the abscess will be done along with administration of antibiotics if it is suspected that the abscess is not drained to its entirety ^[2].

Sitz Baths: This is also an effective way to manage vaginal cysts. The female should fill half a bathtub with warm water and sit on it for about half an hour three to four times a day on a daily basis until the cysts improve. The warm water will allow the smaller cysts to rupture and drain spontaneously and no medication or procedure will be required ^[2].

Marsupialization: This treatment is done for those females who complain of recurrent vaginal cysts. This is done making a permanent opening near the site of the previous drainage to allow the cysts to drain and prevent any chances of recurrence in the future ^[2].

Surgery: This is usually done for cysts that are quite large and requires a surgical incision for drainage of the cyst. This procedure is done under general anesthesia and can be done as an outpatient. An incision is made over the cyst once the anesthesia takes effect and then the cyst is drained ^[2].

Once all the contents of the cyst flow out, the surgeon will place a tube on the opening to allow any further buildup of fluid to drain out. This tube remains in place for a few weeks. This prevents any chances of the cyst to recur ^[2].

In conclusion, vaginal cysts are quite harmless and rarely cause any problem. There are a variety of causes for vaginal cysts. They can develop as a result sexually transmitted diseases. However, the primary cause of a female having vaginal sex is injury or trauma to the vaginal area. The treatment for vaginal cysts depends on the underlying cause ^{[1, 2].}

If the cysts are caused due to an infection, then the cyst will be drained first and then a course of antibiotics will be started. In case if it is a very small cyst then doing sitz baths on a regular basis should be good enough for the cysts to drain away. There are many cases where a female is not even aware that she has a vaginal cyst sur to the location of it until a detailed examination is done of the area for some other purpose ^{[1, 2].}

Vaginal Cysts are rarely painful and if that is the case then the female should seek immediate medical attention as it may be a sign that the cyst is getting infected. It is also recommended that females should avoid doing activities that may irritate the cyst and cause pain and discomfort and require more aggressive treatments ^{[1, 2].}

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