Understanding vaginal cysts

It's natural to feel worried when you find a bump on your vagina. But while it's always a good idea to check for changes in your body, these types of cyst are usually benign which means they are not cancerous.

What is a vaginal cyst?

A vaginal cyst is a fluid-filled lump or bump that can form on the inner walls of your vagina. A cyst that develops on the lips around your vagina (vulva) are called vulval cysts. Both are usually small and don't cause any problems or health risks. However, some cysts can grow larger, which can feel uncomfortable. Larger cysts can become infected which may cause redness and swelling. This infection may result in pain during sex, inserting tampons, or engaging in simple activities such as using the toilet or even just sitting.

What do vaginal cysts look like?

Vaginal cysts form on the inner walls of your vagina. They may be felt as a soft lump during self-examination.

Vulval cysts usually appear as a flesh-coloured, painless bump under the skin of the inner vaginal lips (labia minora). Their size can vary, sometimes resembling a pea-sized pimple. Occasionally, these cysts can be found on the outer vaginal lips (labia majora), causing one side to appear swollen or enlarged.

In most cases, these cysts are harmless and don't require treatment. However, there's a small chance they could become infected and form an abscess. If a cyst becomes infected, you may notice the following signs and symptoms:

• The cyst has become red, swollen, and hurts to the touch.

• A pus-filled pocket has formed inside it.

• There's a bad smell coming from the area.

• You might have a fever and not feel your best.

While infected cysts can be painful and distressing, there's no need to panic. However, it's important to see a doctor to confirm the infection and get treatment, as early diagnosis and care can prevent complications.

What are the different types of vaginal cysts?

Vaginal and vulval cysts come in various forms. In most cases, they are harmless and typically cause no symptoms. If you're worried about a lump, you can always talk to your doctor - even if it's just to put your mind at ease. If you experience pain, discomfort or if the cyst grows or changes in appearance, they can help you decide on the best course of treatment to get you feeling better. Some types of female genital cysts include:

Inclusion cysts - also known as epidermoid cysts - are common cysts that form on the outer vulval skin surface or the inner lining of the vagina.

Bartholin's gland cysts are fluid-filled sacs located on the vulva. They develop inside the Bartholin's glands which sit on either side of your vaginal opening.

Endometrial cysts occur as a result of endometriosis and can be found both inside the vagina and on the vulva¹. These cysts are very rare.

What causes a vaginal cyst?

Vaginal and vulval cysts can have different causes depending on the type. Pinpointing the exact type of cyst can be tricky so it's best not to self-diagnose. However, you shouldn't panic either, as in most cases, these cysts are nothing serious.

Trapped cells and injury: Inclusion cysts can develop when skin cells get trapped beneath the vaginal tissue. This can happen after childbirth, vaginal surgery, or as a result of everyday injury².

Gland dysfunction: Near the opening of the vagina, are two tiny glands called Bartholin's glands. These glands make a lubricating fluid to keep your labia moist and comfortable. Sometimes, the tube draining the fluid gets blocked. When this happens, fluid can build up and form a duct cyst or abscess on the vulva. This is called a Bartholin's cyst. The cause of this blockage is often unclear, though it may result from trauma, irritation or a bacterial infection.

Bartholin's cysts are most common in sexually active women between the ages of 20 and 30. In some cases, a Bartholin's cyst could be triggered by a sexually transmitted infection (STI)³.

Endometriosis: Endometriosis is a health condition that affects women. It's where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This misplaced tissue can be found on the ovaries, fallopian tubes, or other pelvic organs. Rarely, the endometrial tissue can form tiny cysts inside the vagina. In very rare cases they can also grow on the vulva.

Rare causes

Gartner duct cysts: Sometimes small, benign cysts called Gartner duct cysts can form on the walls inside your vagina. These cysts develop as a result of leftover tissue from your development in the womb. They are usually nothing to worry about.

Müllerian cysts: These are similar to Gartner duct cysts though less common. They also occur as a result of material left behind during fetal development. These cysts - filled with a mucus-like fluid - can develop anywhere along the vaginal wall⁴.

Are vaginal cysts contagious?

Most vaginal and vulval cysts occur due to blockages, injuries, or embryonic remnants. Since they are usually not caused by germs, there is only a very slim chance of transmitting them to others through skin-to-skin contact. However, if a cyst becomes infected, the bacteria causing the infection could spread through sexual contact. STIs like gonorrhoea or chlamydia can also increase your chance of developing a Bartholin's cyst. In these cases, the STI itself would be contagious, not the cyst.

If you're anxious about a cyst being contagious, contact your doctor. They can talk about any concerns you have and recommend the best treatment plan.

How long do vaginal cysts last?

Cysts like inclusion cysts can remain for a long time - often going unnoticed if there are no other symptoms⁵.

A Bartholin's cyst usually goes away on its own within a few weeks. If the cyst grows - becoming large and painful - it may need to be looked at by a doctor, as it could be infected.

Endometrial cysts are linked to an ongoing condition, so may stay present for several years. However, a doctor might advise ultrasound monitoring at regular intervals¹. Similarly, Gartner duct and Müllerian cysts might remain for a prolonged period.

If a vaginal or vulval cyst is small, isn't causing you any discomfort and hasn't changed in size or appearance, there's no need to stress. It likely doesn't require medical attention. But if one persists for a few weeks, starts growing, becomes painful, starts to bleed or seems infected, then it might help to visit a doctor.

Cancerous lesions

In some cases, these cysts may be accompanied by additional symptoms that can suggest a more serious condition such as cancer.

While vaginal and vulval cancers are not common - especially for women under 40 - it's crucial to be aware of the symptoms for early detection. The good news is that most female genital cysts aren't cancerous. However, knowing the signs of vaginal or vulval cancer can empower you to seek early diagnosis, which could dramatically improve treatment success. You could also share this knowledge with your loved ones who might have similar concerns.

Key symptoms to look out for:

• A lump that persists or cannot be explained.

• A sore develops on the cyst (becomes ulcerated).

• Vaginal bleeding after menopause.

• Bleeding or pain during sex.

• New difficulty in pooing (constipation).

• Unusual vaginal discharge with a foul odour or blood.

• Bleeding between periods.

• Persistent vaginal itching.

• Painful or frequent urination - not related to a urinary infection.

• Chronic pelvic pain.

• Feeling like you can't fully empty your bowels even after going to the toilet⁶.

• Bloating daily.

Many of the symptoms listed above can also be caused by other easily treatable conditions. But you should still see a doctor for a proper diagnosis, for peace of mind and to receive the right treatment - whatever the condition might be.

If you have any of the symptoms associated with vaginal or vulval cancer, your doctor will refer you to a specialist who will conduct a series of tests. These typically include:

A physical examination - usually of your tummy and pelvis.

A colposcopy - a painless exam using a magnifying instrument (colposcope) for a closer view of your cervix and vagina.

A biopsy - this is where a small piece of tissue is taken from your vagina and sent to a laboratory for microscopic examination.

How are vaginal cysts treated?

If your cyst is symptomless, you likely won't need treatment or further tests. However, it's completely understandable to feel worried. If you have any questions or concerns, your doctor will be more than happy to talk through them.

For sore or possibly infected cysts - particularly in the case of Bartholin's - a doctor may recommend some simple steps you can take at home to help relieve the pain. These include:

• Soaking the cyst in a few inches of warm water (sitz bath) for 10-15 minutes several times a day for 3-4 days.

• Gently pressing a warm compress - such as a flannel or cloth - against the area.

• Taking over-the-counter painkillers such as ibuprofen or paracetamol.

If a cyst becomes infected and forms a painful abscess, your doctor may prescribe antibiotics to clear up the infection. If the abscess is especially large, they may advise draining the cyst to prevent future problems and to reduce its chance of coming back. In this case, your doctor may refer you directly to your local emergency department.

There are a few minor medical procedures used for treating a genital cyst or abscess:

Balloon catheter insertion: A thin, flexible tube (catheter) with a small balloon at the end is inserted into the abscess. The balloon is then gently inflated with salt water (saline solution) to make a small opening. This opening stays in place for several weeks to help drain the pus and keep the area clear.

Marsupialisation: If the cyst keeps coming back, a surgical procedure called marsupialisation might be recommended. This is where a small cut is made in the cyst to let the pus or fluid completely drain. After this, it's stitched back up in a special way that leaves a tiny opening resembling a kangaroo's pouch. This allows any future fluid to drain freely, reducing the chance of future blockages.

Removal of the Bartholin's gland: If your infected cyst is related to a Bartholin's cyst, surgery to remove the affected Bartholin's gland may be needed if other treatments have not been effective or it is recurring frequently.

While cysts in and around the vagina - even infected ones - rarely pose a serious health threat, understanding the symptoms of more concerning conditions is helpful. Don't hesitate to speak to your doctor about a genital cyst, no matter how minor you think it may be. Talking openly to your doctor is vital for peace of mind. You can also talk to friends and family – normalising open communication about sensitive matters can help us all feel less alone and fearful about discussing vaginal health.

Further reading

1. Tiufekchieva et al: [Endometrial cysts of the vagina and the vulva (case reports and a literature review)]

2. Machairiotis et al: Postpartum vaginal cystic lesions: everyday practice or a differential diagnosis challenge?

3. Elkins et al: Association of Bartholin cysts and abscesses and sexually transmitted infections

4. Purandare et al: Rare co-occurrence of a Mullerian cyst and a Gartner's duct cyst

5. Weir et al: Epidermal Inclusion Cyst

6. Cancer Research UK: Symptoms of vaginal cancer