Nabothian cyst are benign formations that form when the lumen of the cervix glands is blocked and mucous secretions accumulate in them. Pathology may be preceded by pseudo-erosion. Clinical manifestations are usually absent. The contents of cysts sometimes become a breeding ground for microorganisms, which leads to the addition of inflammation, accompanied by symptoms of cervicitis. Diagnosis is based on the data of gynecological examination, colposcopy, biopsy and ultrasound of the pelvis. Treatment is carried out by methods of destruction, with infected cysts, antibiotic therapy is indicated.
N88.8 Other specified non-inflammatory diseases of the cervix
Nabothian cysts can occur at any age. In young unborn girls, they are often combined with ectropion. At the fertile age, retention cysts of the cervix are often diagnosed in women who live an active sexual life against the background of cervicitis and vaginitis. After the onset of menopause, due to a decrease in estrogen levels and the development of atrophic processes, multiple small nabote cysts can form in the vagina, which are combined with leukoplakia, cervical hypoplasia and diffuse or focal cervix atrophy.
Nabothian cyst do not occur on a healthy unchanged cervix. Pathology is preceded by the appearance of a metaplasia zone, the replacement of the normal multilayer epithelium of the vaginal part of the cervix with cylindrical cells characteristic of the cervical canal. If the provoking factors persist, Nabothian cyst may recur. The main causes of pathology are:
- Ectopia of the cervix. Normally, the junction of the cylindrical and multilayer epithelium is located at the external pharynx. The displacement of the border to the exocervix is accompanied by the processes of proliferation, during which the germination of epithelial cells into the glands causes their blockage and disruption of mucus outflow.
- Cervicitis. Inflammation of the cervix leads to edema, changes in the mechanism of peeling of the epithelium, vascular reaction. The mouths of the glands narrow, may become clogged, which leads to the formation of Nabothian cyst. Their contents serve as a breeding ground for pathogenic microorganisms and support chronic inflammation.
- Hormonal changes. The imbalance of sex steroids is expressed in the pre-menopausal period, as well as with various pathologies in the reproductive age. This causes the appearance of a transformation zone on the neck, in which cells are rearranged, conditions are created for the formation of Nabothian cyst.
- Cervix injuries. After unsuccessful interventions, cervical ruptures during childbirth, epithelial cells are able to shift from the cervical canal to the vaginal portion of the cervix. Next, proliferation processes are started, which can cause a violation of the outflow of secretions of the glands.
Normally, the neck is covered with a multilayer epithelium from the outside, and the cervical canal is lined with cylindrical cells. Under the influence of hormonal changes, with inflammation and injuries, the tissue junction zone shifts from the external pharynx to the surface of the neck, pseudo-erosion is formed. In young women, it may have a physiological origin. At this site, tissue proliferation processes occur, aimed at eliminating the defect.
In the cylindrical epithelium there are multiple passages of glands that synthesize mucosal secretions. The ectopic zone is unstable, it starts the restoration of normal epithelial cover. If epidermization occurs due to the proliferation of multilayer epithelium on the surface of the ectopia, then it blocks the ducts of the glands. Secretions accumulate inside, lead to cystic expansion and the formation of Nabothian cyst.
Perifocal inflammation occurs around cysts, vessels expand and proliferate. The formation of metaplastic epithelium is stimulated, which does not belong to pathologically altered tissues, but in the presence of human papillomavirus increases the risk of dysplasia and cancer. This area of tissue near the nabote cysts is vulnerable to any infections. The causative agents of chlamydia, gonorrhea and other diseases can penetrate into the cystic cavities themselves.
Nabothian cyst in most women are asymptomatic and become an accidental find when visiting a gynecologist. Neoplasms of minimal size are not felt, do not affect sexual life or the ability to conceive. Large cysts can deform the cervix. In this case, pulling pains in the lower abdomen, above the womb, soreness during sexual intercourse may bother.
Pathological whites, mucous or pus-like secretions appear when Nabothian cyst are combined with cervicitis or vaginitis. With a nonspecific infection, the color of the discharge ranges from yellow-green to gray. Sometimes they are abundant or moderate in quantity, cause itching, burning and irritation of the vestibule of the vagina. There is a possibility of infection spreading upward into the uterus and appendages.
Retention cysts rarely lead to serious complications, but when infected, they become a focus that supports chronic inflammation. Often complicated by chlamydia, when chlamydia penetrates, the cyst becomes a reservoir for the preservation of the microorganism. Women who have been treated for sexual infections, against the background of self-opening of the cyst, may face reinfection, which will require a new course of treatment.
For the diagnosis of Nabothian formations, the patient should contact an obstetrician-gynecologist. Often cystic nodules outwardly resemble a preinvasive form of cervical cancer, in such cases, an oncologist’s examination is required. In combination with gonorrhea and other sexually transmitted diseases, a venereologist’s consultation is prescribed. The following diagnostic methods are used:
- Gynecological examination. When examined in mirrors, the doctor may notice single or multiple nodules of whitish or pale pink color on the mucous membrane of the cervix closer to the inner pharynx. With inflammation, the tissue around the Nabothian cyst is hyperemic, discharge appears from the neck.
- A smear from the vagina. It helps to determine the inflammatory process, the composition of the microflora. In the presence of a large number of leukocytes, the predominance of coccal flora, anti-inflammatory treatment is indicated.
- PAP test. A smear for oncocytology reflects the state of cells in the ectopic region. Normally, epithelial cells of normal structure and regular shape should be determined. The change in the nuclear-cytoplasmic ratio, the appearance of atypical cells and other signs of dysplasia are alarming.
- Colposcopy. Upon examination, it is possible to identify Nabothian cyst of minimal size. Extended colposcopy indicates a displacement of the epithelial junction zone to the vaginal part of the cervix. In infectious processes, there are characteristic changes in the vascular pattern, a decrease in the amount of glycogen.
- Biopsy. It is indicated for suspected cervical dysplasia, which may accompany pseudoerosion and cystic formations. It is performed during an extended colposcopy, samples from suspicious areas are taken for histological examination.
- Gynecological ultrasound. A necessary stage of diagnosis when a woman complains of pain over the womb, dyspareunia. Preference is given to vaginal examination, which allows the most accurate study of the standing of the internal genitalia.
The need to treat cysts on cervix causes controversy among gynecologists. Many experts say that with single formations of minimal size, treatment is not indicated, regular monitoring is necessary, prevention of inflammatory processes. According to another opinion, Nabothian cyst are a provoking factor for the development of infectious diseases, serve as a breeding ground and reservoir for pathogenic bacteria, therefore they require removal.
Treatment is carried out on an outpatient basis under the supervision of a doctor of a women’s consultation. With confirmed inflammation of the cervix, medications designed to fight infection are used. Preference is given to local remedies, systemic drugs can be used according to indications. The main directions of drug therapy:
- Antiseptics. Candles with antiseptics are shown for the treatment of the vagina. Chlorhexidine, iodine preparations (in the absence of allergies) in the form of vaginal suppositories are effective. The duration of the course of treatment depends on the severity of the symptoms.
- Antibiotics. Antibacterial drugs in the form of combined candles help with nonspecific cervicitis in combination with retention cysts. Systemic antibiotics are prescribed for specific infections – chlamydia, gonorrhea, trichomoniasis.
- Lactobacillus. It is recommended after a course of antibiotic therapy of the formations of the mammary glands to restore the composition of the normal microflora of the vagina. Some drugs contain estrogens, which improves the process of colonization by bacteria of the mucous membrane.
The destruction of the capsule of the nabot cyst allows its contents to be removed, then the substrate for its formation is eliminated – the zone of displaced epithelium. Methods of destruction are selected individually, determined by the age of the woman and her reproductive plans. Sparing methods that do not cause scarring of the cervix are recommended for young and unborn. Treatment is carried out in the following ways:
- Chemical moxibustion. Enzyme preparations are used that provoke chemical damage to the surface layer of cervical tissues, destroy cystic cavities and pseudo-erosion. In the long-term period, the scar does not form, but there is a risk of relapse.
- Cryodestruction. After the puncture of the nabot cyst, a round tip filled with liquid nitrogen is applied to its bed. A cold burn occurs, which gradually heals with the formation of healthy tissues.
- Radio wave method. The device “Surgitron” is used. The opened Nabothian cyst is treated with radio waves that coagulate the vessels and the bed. The method is highly effective, does not lead to the development of complications, can be used in women of any age.
- Laser coagulation. Cauterization of Nabothian cysts and the eroded surface of the cervix occurs painlessly. Healthy tissues are not damaged, the instrument does not come into contact with the surface of the cervix, so there is no risk of infection and subsequent complications. The recovery period is short, scarring does not occur.
- Electrocoagulation. Quite traumatic manipulation, which is used in women who do not plan to have children. The cyst is opened, its cavity and altered cervical tissues are cauterized with an electrocoagulant. During healing, there is a risk of scarring, stricture of the cervical canal.
- Conization of the cervix. The procedure is used for the treatment of the nabot cyst of the cervix only when it is combined with dysplasia of 2-3 degrees. The method consists in removing the cervical fragment in the form of a cone directed by the tip to the uterine cavity. The procedure is performed in the operating room under general anesthesia.
Prognosis and prevention
With timely access to a doctor, the prognosis for Nabothian cyst is favorable. After treatment, the epithelial cover is restored, the development of deformity or scarring of the cervix is uncharacteristic.
Prevention consists in preventing the formation of pseudoerosion and its infection. To do this, you need to avoid casual sexual contact, use a condom during sex, and timely treat vulvovaginitis. Women of reproductive age and girls living a sexual life should visit a gynecologist for a preventive examination at least once a year.