A wide variety of ‘lumps’ occur on the vulva and within the vagina. Most of these are benign but a few are either premalignant or cancerous. The challenge to the clinician is to differentiate between normal variants, benign findings, and potentially serious diseases.
TYPES OF LESIONS ON THE VULVA OR VAGINA
Examples of cysts include:
Gartner duct cysts of the vagina
- During fetal development a number of structures form and then regress/disappear before childbirth or shortly afterwards. Occasionally remnants persist and one of these is called a Gartner’s duct. For various reasons these ducts may accumulate fluid and become known as Gartner duct cysts. These usually form in adulthood.
- Most of the cysts appear as solitary lesions and are located in the front/side-wall of the upper portion of the vagina and are painless. Frequently these cysts are discovered incidentally while the individual is being examined for other medical conditions.
- In some cases these cysts may grow to larger sizes resulting in discomfort and pain.
- Surgical management to remove the cyst may be considered in some cases.
Vaginal inclusion cysts
- These are the most common type of vaginal cysts. This type of cyst is caused by an injury to the wall of the vagina e.g. during childbirth or after surgery.
- Most of the time these cysts do not cause any symptoms, hence no treatment is required.
- The Bartholin’s glands are two pea-sized glands located under the skin slightly below and to the left and right of the opening of the opening of the vagina. Most of the time you can’t feel or see these glands. The Bartholin’s glands produce a small amount of fluid (mucus) that moistens/lubricates the lower vagina and the outer genital area. This fluid comes out of two tiny tubes (ducts) next to the opening of the vagina.
- If a Bartholin’s duct gets blocked, fluid builds up and forms a swelling or cyst. It’s often not known why the ducts become blocked, but some cases are linked to sexually transmitted bacterial infections such as gonorrhoea or chlamydia, or other bacterial infections such as Escherichia coli.
- A Bartholin’s cyst is usually asymptomatic – you may feel a soft, painless lump. However, these cysts may slowly enlarge, ranging in size from a pea to a large marble.
Most cysts in the vulval or vaginal area are entirely asymptomatic and no intervention or treatment is required. However, they may become bothersome if they enlarge and cause discomfort or pain. Simple measures can be used initially such as cold-compress if inflamed, soaking the cyst in warm water and/or taking over-the-counter painkillers. If the cyst remains bothersome, antibiotics or surgery to remove the cyst may be considered.
- An infected cyst may develop into an abscess (painful collection of pus), requiring treatment with antibiotics and/or surgical drainage.
- Surgery for vulval/vaginal cysts or abscesses is generally a relatively minor procedure, performed as a day case under general anaesthesia. Occasionally, drainage of smaller abscesses can be performed using local anaesthesia in an outpatient setting.