Vaginal cysts, which are closed sacs or pockets filled with air, pus, fluid or other material, can develop along the walls and/or surface of the vagina. Vaginal cysts occur with the blockage of a gland or duct, preventing the liquid or other materials from escaping and forming a sac. Typically, cysts are benign (noncancerous) and asymptomatic, which means for many women, they may not even know they have one. 

Most vaginal cysts are not problematic or serious, and therefore do not need to be treated, but some cysts can create a problem by producing discomfort, pain or introduce complications—particularly in cases of infection or growth in size. Vaginal cysts vary in size from very small (peapod size) to very large (orange size). There are some cysts that are so small they remain unnoticed, and there are others that become large enough to create pressure or visible swelling. 

Vaginal cysts are rare in the occurrence of vagina gynecology issues, but they can happen at any age. Some cysts may be congenital (existing at birth). Many vaginal cysts do not produce symptoms. However, they can interfere with comfortably having sex, using tampons or any other insertion into the vagina.

Having more knowledge about cysts, causes of cysts and management of cysts will help toward denying any disturbances to overall reproductive health and wellness.

Vaginal cysts can be classified into various types, depending on their development, origin and contents.

Each type arises through different tissues or glands and may have different features. 

• Vaginal Inclusion Cysts: Vaginal inclusion cysts are the most prevalent type of cysts that develop in the vagina and are usually small. They occur from trauma, either because of childbirth, surgery or injury to the vagina. Once the vaginal wall sustains damage, some of the epithelial cells can become entrapped and continue to divide, forming a cyst. Sometimes inclusion cysts are quite small and painless, and just discovered by accident when a physician performs a pelvic examination. 
• Gartner’s Duct Cysts: Gartner’s duct cysts arise from remnants of the Gartner duct, which could be present during fetal development. This duct is normally very small and disappears before birth, however, when remnant portions are found, they usually appear later in life. Gartner’s duct cysts usually appear on the upper walls of the vagina and are frequently discovered during pelvic examinations or imaging.
• Bartholin’s Cysts: The Bartholin glands are located on either side of the vaginal opening and are responsible for producing lubrication for the vagina. When the duct of a Bartholin gland is blocked, the fluid builds up resulting in a cyst. These cysts can be painless to quite painful, especially if they become infected and turn into a Bartholin’s abscess. They can cause noticeable swelling and discomfort to the point of limited mobility while walking, sitting or during sexual activity. 
• Skene’s Duct Cysts: Skene’s glands, otherwise known as the female prostate, are located near the urethral opening. When these ducts are blocked, the result can be Skene’s duct cysts. These can be rare, but when they occur, they can cause a sense of pressure or discomfort in the perineum near the urethra and sometimes discomfort with urination. 
• Sebaceous Cysts: Sebaceous cysts occur when the oil-secreting sebaceous glands of the vulva (external genitalia) are blocked. Sebaceous cysts tend to be on the outer lips of the vagina (labia) and are filled with a yellow-white, greasy material. Sebaceous cysts are generally harmless but can occasionally become inflamed or infected.
• Mullerian Cysts: Müllerian cysts develop from residual tissues in the Mullerian ducts, which are involved in female reproductive organ development in the fetal life. Cysts can develop on the walls of the vagina and often contain mucus. They are typically benign and asymptomatic. They may be found incidental at exams of the pelvis.

The causes of vaginal cysts vary by type, but several typical causes can lead to vaginal cysts:

• Injuries or Trauma: Physical trauma due to childbirth, surgical procedures, or sexual intercourse may result in vaginal inclusion cysts. Vaginal inclusion cysts develop when epithelial cells become entrapped under the surface during healing. Vaginal inclusion cysts generally develop asymptomatically, likely cannot be prevented, and likely form without warning.
• Blocked Glands: Blocked ducts in glands such as the Bartholin (which is below the vaginal opening) or Skene glands (located around the urethra) depend on the modification of fluids and will become cysts. Practicing good hygiene may minimize the risk of infection associated with cysts formed via blocked glands, however, the duct itself is unlikely to have presented with warning signs prior to obstruction.
• Congenital Anomalies: Vaginal cysts may occur as a component of remnants of developing embryonic structures such as Gartner’s duct cysts and Müllerian cysts that were never completely regressed embryonically. Congenital anomalies identified easily with imaging modalities such as MRI, may not be apparent until later in life.
• STIs (Sexually transmitted infections): In rare cases infections such as Chlamydia or gonorrhea may hinder a Bartholin cyst because they could cause inflammation/blockage of the gland duct. Practicing safe sex such as using condoms can minimize the risk of sexually transmitted infections and more serious infections and complications from vaginal cysts.
• Hormonal Variations: Hormonal variations could alter the activity of the vaginal or vulvar glands and change the consistency of glandular secretions. As a result, there can be an increased risk of a duct being blocked, especially with menstruation, pregnancy or menopause.
• Endometriosis: In rare circumstances, vaginal cysts may be associated with endometriosis, a condition in which tissue similar to the uterine lining grows outside the uterus. When endometrial implants develop near or within the vaginal area, they can sometimes form cyst-like structures.

Understanding the possible sources of vaginal cysts can assist in early detection and effective treatment. While not all sources can be prevented, practicing good hygiene, safe sexual practices and timely medical treatment may lessen the risk of complications.

Vaginal cysts are not contagious and are generally caused by internal rather than external factors. They can happen on their own, but some risks of probable causes may include:

• Injuries during childbirth or tearing of the vaginal walls
• Surgery (including episiotomy)
• Poor hygiene (surrounding infection in pre-existing cysts)
• Occlusion of the ducts in the vaginal or vulvar glands
• Remnants of embryonic development (Gartner’s ducts or Müllerian ducts)
• Chronic infection or inflammation of the vaginal area.

While there is often an unknown cause, most cysts are harmless and incidental. However, any new or odd lump should be evaluated by a medical professional.

Many vaginal cysts are small, painless and go unnoticed. However, cysts can be large and/or become infected or inflamed, which can lead to noticeable symptoms.

Signs and symptoms may include:

• A small, round lump in or near the vaginal wall
• A feeling of fullness or swelling in the vaginal area (larger cysts)
• Discomfort or pain during sexual intercourse (dyspareunia) or while placing a tampon
• Pain/discomfort while walking or sitting (particularly if larger or in an inflamed state)
• Redness/warmth/tenderness (if the cyst is infected)
• Foul-smelling discharge (could be suggestive of rupture or abscess formation)
• Fever and general illness (if infected)
• Sensitivity or tenderness to touch

Some cysts (like Bartholin’s cysts) may be painless, yet if become infected, they may range in severity from painless to very painful.

If you notice a new lump, experience pain or any discharge from the vaginal area, it would be best to be properly evaluated and diagnosed for treatment.

To diagnose a vaginal cyst, healthcare providers will usually take a clinical history, perform imaging, and possibly laboratory work—depending on the cyst in question.

• Clinical History and Physical Examination: The healthcare provider begins by taking a clinical history that includes diagnostics for symptoms, surgeries, childbirth, trauma and infection history. The first step is a pelvic exam to look for lumps, swelling, tenderness and/or signs of infection.
• Imaging: Imaging may also be indicated and may be used if the cyst is large, persistent or unusual to evaluate with imaging, and could include:
• Ultrasound: A diagnostic ultrasound is commonly used to evaluate if the cyst is solid, or cystic.
• MRI or CT Scan: MRI or CT scan is rarely needed unless the cyst has complex features or isn’t characterized and further evaluation is needed to measure depth, size and surrounding structures.
• Laboratory Evaluation: Laboratory evaluation may be performed by the healthcare provider if infection is indicated. Swabs for cultures to evaluate for bacteria and sexually transmitted infections (STI infection) Samples of fluid from the cyst (if the cyst is drained) for culture to evaluate for pathogens. Laboratory tests including blood work looking for evidence of systemic infection, such as an elevated white blood cell count.
• Biopsy: If a cyst appears to be abnormal, grows rapidly, or fails to shrink in response to treatment, a biopsy may be indicated. In a biopsy, a small amount of tissue is taken from a cyst and examined under a microscope to exclude the possibility of malignancy or unusual infections. 

In most instances, small cysts that are not symptomatic are monitored together with the patient to detect if the cyst grows or develops symptoms, especially if no active intervention is suggested.

The way vaginal cysts are managed depends on the type of cyst, size, symptoms and whether the cyst is infected or causing pain or other problems. For example, many cysts in the vagina are benign and do not require treatment whatsoever, while others involve medical or surgical treatment.

• Observation (Watchful Waiting): If the cyst is small, not painful, and is not causing symptoms, no treatment may need to be performed. Many vaginal cysts either stay the same size or disappear on their own with time. Your doctor may suggest regular follow-up with your routine gynecological exams.
• Home Treatment: For mild symptoms or early-stage cysts, some home treatments can be useful in the interim:
  • Warm sitz baths: It may be helpful to sit in warm water for 15-20 minutes for several days up to several times a day to relieve pain and encourage drainage from the cyst.
  • Good hygiene: Keep the genital area clean and dry to minimize the chance of infection.
• Medical Treatment: Medical treatment may be required if your symptoms worsen or you start showing signs of infection.
• Antibiotics: If the cyst becomes infected, your doctor will prescribe antibiotics. You may receive topical or oral antibiotics, depending on the severity of the infection.
• Pain relievers: Non-steroidal anti-inflammatory medications (NSAIDS) such as ibuprofen can help reduce swelling and alleviate pain and discomfort. For very painful cysts, taking the recommended dose can help relieve the pain and allow you to breathe a sigh of relief.
• Surgical Drainage: Your doctor may want to drain larger, painful cysts, and infected cysts, especially Bartholin’s abscesses.
  • Incision and drainage (I&D): An incision is made to drain the fluid from the cyst, and sometimes to go deeper into the gland.
  • Word catheter insertion: After drainage, the doctor places a small tube with a balloon tip into the cyst cavity. The tube allows the site to drain over several weeks. When the cyst cavity is properly drained, the cyst heals properly, and recurrence is less likely.
• Marsupialization: Marsupialization is a simple operation often done for a recurrent Bartholin’s cyst. During the procedure, the surgeon opens the cyst and creates a small permanent cut in the cyst wall so the edges can be stitched open. By providing a small opening, the cyst can drain continuously, and recurrence is unlikely.
• Excision (Surgical Removal): Complete removal of the cyst may be suggested under certain conditions:
  • The cyst is recurrent or does not respond to conservative treatment.
  • There may be concern for malignancy especially if the patient is over 40 years of age.
  • The cyst is very large or is causing significant symptoms.
  • Excision is typically performed under local or general anesthetic. Once completely excised, these cysts typically do not return.
• Biopsy: A biopsy may be performed when the cyst appears abnormal or if there is concern for cancer. During the biopsy, a small piece of the cyst is taken and examined under a microscope to see if there is cancer. Biopsies are more often undertaken in older patients or when the cyst has suspicious features.

Risks associated with cysts in the vagina are uncommon.

Minor complications can develop when a vaginal cyst develops to be sizable, infected or inflamed. 

These complications might include: 

• Serious infection, which could develop an abscess that you may need draining right away. 
• Pain and discomfort, especially larger cysts tend to be. 
• Pain during sexual intercourse or dyspareunia, which could occur if the cyst pushes on the surrounding tissue and causes discomfort. 
• Anxiety and or emotional distress, especially in the case that you may have mistaken the cyst for a tumor. 
• Recurrence, as in the case of a Bartholin’s cyst, they may recur even with drainage or surgical intervention.

It is also rare that other cysts may be hiding or can be mistaken for a malignancy. Because of that, any non-resolving, abnormal or unexpected masses in the vagina should always be addressed by your healthcare provider as first-line management.

Vaginal cysts (which are typically harmless) are pockets of fluid that occur in or around the vagina. Vaginal cysts can develop for various reasons, including injury, blocked glands, or remnants of embryonic structures that didn’t fully disappear during development. These cysts are typically asymptomatic and are often discovered incidentally during routine medical exams or Pap smears. In many cases, cysts can be treated with medical or surgical intervention if they become sufficiently enlarged, infected or painful. 

Establishing healthy genital hygiene practices, soaking in warm sitz baths and avoiding irritants can relieve very mild symptoms. Whether or not vaginal cysts are symptomatic, patients should be encouraged to seek medical care for situations with persistent or painful swelling of the vagina. Receiving a timely diagnosis and appropriate care can ensure patient comfort and no complications while providing the patient with peace of mind. 

Vaginal cysts do not typically warrant high levels of concern. Nonetheless, detection of and awareness about cysts so they can be treated should be of significant value to women. Encouraging women to speak seriously to medical provider about concerns, which is encouraging the patient to be active consumers of the services the health care providers provide, is the best medical practice.  All women should know that they can speak to medical providers with confidence no matter what the issue and not feel shame.

• American College of Obstetricians and Gynecologists. (2020). Bartholin gland cysts and abscesses. ACOG. 
• Mayo Clinic. (2023). Vaginal cysts. Mayo Foundation for Medical Education and Research. 
• Berek, J. S., & Berek, D. L. (2019). Berek & Novak’s gynecology (16th Ed.). Wolters Kluwer.
• MedlinePlus. (2023). Vaginal cyst. U.S. National Library of Medicine. 
• UpToDate. (2024). vaginal cysts: Types, diagnosis, and treatment. Wolters Kluwer Health.