Vaginal cyst is a retention tumor–like formation of the vaginal wall that does not have proliferative growth, but increases as a result of the accumulation of liquid contents. Vaginal cysts develop asymptomatically for a long time and are more often detected during oncoprophylactic examinations by a gynecologist. When a cyst reaches a large size, it can interfere with sexual activity or become inflamed. Diagnosis of a vaginal cyst is carried out with the help of gynecological examination, colposcopy. Surgical treatment – removal of the vaginal cyst.
The cyst of the vagina can be located superficially or penetrate into the depth of the tissues and reach the periaginal tissue. The size of cystic tumors of the vagina sometimes reaches the size of a walnut or a chicken egg. The shape of the vaginal cyst is round or ovoid, the consistency is soft or tight-elastic.
The walls of the cyst are externally represented by connective tissue with elements of muscle tissue; from the inside, the cavity is lined with cylindrical, prismatic or cubic epithelium. The contents of the cysts are transparent (serous or mucous), yellowish or dark brown in color. Nowadays, clinical gynecology detects vaginal cysts in about 1-2% of patients, mainly at a young age. Cases of the development of malignant tumors from the vaginal cyst have not been described in medical practice.
Cysts are not true vaginal tumors. In gynecology, there are congenital and traumatic (acquired) vaginal cysts. Congenital cysts can develop from the embryonic parts of the Muller or paraurethral ducts, Gartner’s passages. Cysts emanating from Gartner’s passages are usually located on the side walls of the vagina, at the level of the arches, sometimes with a transition to parametric fiber. Muller duct cysts are often combined with vaginal malformations (vaginal atresia).
Less common are vaginal implantation cysts formed by epithelial elements that have penetrated into the thickness of tissues during surgical termination of pregnancy, birth injuries, surgical treatment of vaginal fistulas, elimination of postpartum ruptures and scars, etc. For implantation cysts, predominant localization in the posterior wall of the lower parts of the vagina is characteristic.
Usually vaginal cysts have an asymptomatic course and are often detected by a gynecologist during a routine examination. With a large cyst size, there may be sensations of a foreign body in the vagina, discomfort and pain during sexual intercourse, dysuric disorders and defecation disorders. Ulceration of the integument, infection and suppuration of the contents of the vaginal cyst may be accompanied by pathological whites, increased soreness, signs of colpitis.
If a vaginal cyst is detected in a woman during pregnancy, the tactics depend on the size of the retention formation. Small-sized cysts do not prevent independent childbirth, therefore they are not subject to removal. With giant cysts blocking the birth canal, they can be aspirated or removed, or delivery by caesarean section is planned.
Vaginal cysts are diagnosed during gynecological examination with the help of mirrors; they look like round or oblong formations of a tight-elastic or soft-elastic consistency. Vaginal cysts are differentiated with vaginal wall prolapse, cystocele, rectocele, urethral deverticules; if necessary, urologists and proctologists are involved in the diagnosis.
Before the operation to remove the vaginal cyst, colposcopy, bacteriological and microscopic examination of smears are additionally performed. With the help of ultrasound, the position of the cyst relative to the parametric fiber, rectum and bladder is clarified.
Asymptomatic vaginal cysts of small size require only dynamic observation; cystic formations that increase in size or manifest themselves clinically are subject to surgical removal – peeling from the underlying tissues. Puncture aspiration of cyst contents, as a rule, gives a temporary result. In this case, the cystic tumor of the vagina soon accumulates the contents produced by epithelial cells again. This tactic may be justified in pregnant women with giant vaginal cysts. A safe and gentle method of removing a vaginal cyst is marsupialization – dissection and emptying of the cyst with stitching its walls to the mucosa.
During the radical removal of the vaginal cyst, the mucous wall is dissected by a longitudinal incision; the cyst is exfoliated in a blunt and acute way; catgut sutures are applied to the bed and mucous membrane. When Gartner’s cysts are hatched from the underlying tissues, the course of the operation may be complicated by damage to the rectal wall or bladder, since these formations often go deep into the paravaginal, parametral and paravesical fiber with the upper pole. Therefore, if it is impossible to remove the cyst with extra-vaginal access, laparotomy is resorted to.
Prevention and prognosis
Prevention of the formation of congenital vaginal cysts requires ensuring normal conditions for the course of pregnancy and the laying of fetal organs. Prevention of traumatic cysts consists in careful performance of vaginal manipulations and careful management of childbirth.
In case of accidental detection of asymptomatic vaginal cysts, dynamic monitoring is established for their growth and development. Vaginal cysts do not affect menstrual and reproductive function. With a tendency to increase the size of the cyst, the appearance of clinical symptoms, complicated course, excision of the formation is performed. With incomplete exfoliation of the vaginal cyst or puncture aspiration of the contents, the recurrence of tumor-like formation is possible.