Where does the cyst come from?
During fetal development, the embryo has paired mesonephric ducts known as Wolffian ducts. In boys, the vas deferens are formed from them; in girls, they should be completely reduced by the time of birth. If a small section of the duct remains in the thickness of the side wall of the vagina, its cells continue to produce secretions. The liquid accumulates, forming a cavity with a thin wall. Such cysts are usually single, located on the anterolateral wall, usually in the upper third of the vagina, and range in size from several millimeters to several centimeters.
- Remnant of mesonephric duct
- Location on the anterolateral vaginal wall
- Single formation with a smooth surface
- Contents: clear or yellowish liquid
- Sometimes combined with abnormalities of the uterus and kidneys
- Difference from Bartholin gland cyst by location
Symptoms
Most cysts do not cause any sensation and become a finding during a routine examination. If the size is more than two to three centimeters, the woman herself can feel the smooth elastic formation or feel pressure. There may be discomfort and pain during sexual intercourse, a sensation of a foreign body when walking, and inconvenience when using tampons. Large cysts located close to the urethra sometimes cause frequent urination or a feeling of incomplete emptying. Pain and redness appear only when the contents become infected, which is rare.
- Most often there are no complaints
- Sensation of a foreign body in the vagina
- Discomfort or pain during intercourse
- Palpable smooth elastic formation
- Pressure on the bladder, frequent urination
- Difficulty inserting a tampon
- Pain and redness during suppuration
How to examine
The diagnosis is usually made by examination in a speculum: the cyst looks like a round formation under the unchanged mucosa, soft and mobile. To clarify the size and depth, ultrasound examination, including transvaginal examination, is used. Large cysts that extend deep into the tissue or are located high require MRI of the pelvis before planning surgery to assess their relationship to the ureter and bladder. If a connection with the urinary tract is suspected, the kidneys are additionally examined, since combined congenital anomalies are possible.
- Gynecologist examination in mirrors
- Transvaginal ultrasound
- MRI of the pelvis for large and deep cysts
- Ultrasound of the kidneys if a combined anomaly is suspected
- Differential diagnosis with urethral diverticulum
- Histological examination after removal
What can be confused with
Similar formations in the vagina are the Bartholin gland cyst, which is located lower, at the entrance to the vagina, and inclusion cysts after birth ruptures or operations. It is important to exclude a urethral diverticulum: when pressing on it, urine or pus may be released. In women with prolapse of the vaginal walls, the bulge can be mistaken for a cyst. Separately, the doctor excludes tumor formations, especially if the consistency is dense, the surface is uneven, or there is bleeding. If there is any doubt, MRI helps.
- Bartholin gland cyst
- Urethral diverticulum
- Inclusion cyst after rupture or surgery
- Vaginal wall prolapse and cystocele
- Vaginal endometrioid cyst
- Benign and malignant tumors
Treatment
Small asymptomatic cysts do not require treatment - observation with an examination once a year is sufficient. If the formation interferes, grows, causes pain when close, or puts pressure on neighboring organs, it is removed. The best option is complete excision of the cyst along with the membrane, since simple opening or puncture almost always leads to re-accumulation of fluid. The operation is performed under local or general anesthesia and usually does not require a long stay in the clinic. The removed material is sent for histological examination.
- Observation for small asymptomatic cysts
- Complete excision of the cyst with capsule in case of complaints
- Refusal of simple puncture due to frequent relapses
- Preoperative assessment of proximity to the urethra and ureter
- Histological examination of the removed cyst
- Opening and drainage during suppuration
- Sexual rest during the healing period
