What is a vulvar cyst?

A vulvar cyst refers to a cystic mass that grows on the labia majora or perineum of women, often occurring in the deep tissues beneath the vulvar skin or mucosal epithelium. It is most commonly found on the labia majora and perineum^[1,2]. The cyst may be solitary (a single cyst) or multiple (several cysts), and it is predominantly benign^[1,2].

What are the types of vulvar cysts?

Based on the location of the cyst, the following classifications exist:

Common clinical types include Bartholin's gland cysts, epidermal cysts, labia minora cysts, and sebaceous cysts^[2].

• Bartholin's gland cyst: Caused by blockage of the Bartholin's gland duct in the vulva.
• Epidermal cyst: A cyst that forms in the superficial skin layer of the vulva.
• Labia minora cyst: A cyst that appears on the labia minora.
• Sebaceous cyst: Caused by abnormal development or blockage of the sebaceous gland duct.

Less common types include vulvar endometriotic cysts, apocrine sweat gland cysts, mesonephric duct cysts, and dermoid cysts^[2].

What causes vulvar cysts?

The causes vary depending on the clinical type, but common factors include:

• Pathological factors: Include glandular duct obstruction and abnormal tissue development in the vulva. Glandular duct obstruction occurs due to blockages in glands such as the Bartholin's or sebaceous glands, preventing the discharge of secretions. Abnormal vulvar development is often congenital, arising during embryonic development.
• Medical procedures: Surgical errors or poor postoperative recovery in procedures like episiotomy or perineal repair may lead to vulvar cysts, such as epidermal cysts or endometriotic cysts^[1].
• Hygiene factors: Poor vulvar hygiene can lead to the accumulation of secretions and bacterial growth^[3].

Who is most likely to develop vulvar cysts?

Vulvar cysts can occur in females of any age, from young children to postmenopausal women. Bartholin's gland cysts are the most common, particularly in the following groups^[1]:

• Women with poor vulvar hygiene.
• Women who sit for prolonged periods.
• Sexually active women of reproductive age.

What are the main symptoms of vulvar cysts?

Symptoms vary depending on the type of cyst:

• Simple cysts: Typically asymptomatic and often discovered incidentally during self-examination or medical check-ups. They may feel like pea- to egg-sized lumps^[1,3].
• Large cysts: May rupture or become infected, causing redness, swelling, heat, pain, and purulent discharge. Larger cysts can also cause a dragging sensation, discomfort while walking or sitting, and pain during intercourse^[1-3].
• Special cysts: Vulvar endometriotic cysts may appear as bluish-purple nodules that enlarge and cause pain during menstruation^[1].

Which department should I visit for vulvar cysts?

Gynecology.

How are vulvar cysts diagnosed? What tests are needed?

Diagnosis is based on medical history, cyst size, location, and number.

Common diagnostic methods include physical examination, ultrasound, microbiological testing of secretions, or pathological examination after cyst removal^[1].

What conditions can vulvar cysts be confused with?

Labial hernia and inguinal hernia: Both can present as vulvar masses. Differentiation relies on imaging (e.g., ultrasound) or biopsy. Hernias contain protruding organs, while cysts contain mucus-like secretions^[2].

How are vulvar cysts treated?

Bartholin's gland cysts:

Small cysts (<1 cm) without symptoms may not require treatment but should be monitored^[1].
For women aged 40+, some experts recommend incision and drainage for biopsy to rule out cancer^[1].

Enlarging, painful, or infected cysts may require marsupialization or incision and drainage, followed by antibiotics (e.g., quinolones, cephalosporins)^[1,3].

Other vulvar cysts:

Small, asymptomatic cysts usually need no treatment^[1].

Large cysts, those with solid components, or unclear diagnoses may require surgical excision and pathological examination. CO₂ laser therapy may be used for multiple apocrine ductal cysts^[1].

How likely is a vulvar cyst to recur?

Most vulvar cysts are benign and rarely become malignant.

Bartholin's gland cysts may recur in sexually active women due to duct re-blockage, requiring repeat marsupialization. Other types rarely recur after excision^[1].

What lifestyle adjustments are needed after diagnosis?

Maintain vulvar hygiene: Clean daily, wear breathable underwear, and change it frequently to reduce infection risk^[4].

Avoid sexual activity during treatment and recovery.

How can vulvar cysts be prevented?

Prevention focuses on reducing glandular duct blockages^[1,3]:

• Practice good vulvar hygiene: Wash daily, change underwear, and keep the area dry. Clean thoroughly before and after intercourse.
• Avoid prolonged sitting; engage in gentle exercises like yoga.