Benign Cysts of the Vulva and Vagina: A Comprehensive Review for the Gynecologic Surgeon

Abstract

Importance Gynecologists are experts in providing care to women with vulvovaginal complaints. Cysts located in the vagina and vulva can cause pain and irritation and incite concern. Given the relatively low prevalence of these cysts in the population, helpful diagnostic and management information for providers is scarce. Objective This article will detail the epidemiology, embryology, presentation, and management of vulvovaginal cysts. Evidence Acquisition We completed a comprehensive literature review for all available data and included case reports, case series, histological studies, and descriptive articles obtained from PubMed and relevant textbook chapters. Results In general, cystic lesions of the vagina and vulva are typically benign and asymptomatic and do not require intervention. Special attention should be paid to cysts arising in women older than 40 years and those that are fixed or associated with pain or bleeding. Cysts that require management may require imaging, often either with transvaginal ultrasound or magnetic resonance imaging. Surgical excision, when necessary, has a high success rate. Conclusions and Relevance Vaginal and vulvar cysts have a myriad of presentations and etiologies. A thorough understanding of these is helpful to guide decisions about further testing and management options. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completion of this CME article, the reader should be better able to assess the embryology underlying vulvovaginal cysts; describe the differing presentations of various vulvovaginal cysts; identify patient risk factors and clinical presentations that warrant further workup versus expectant management; and explain the benefits and pitfalls of various imaging modalities in imaging vulvovaginal cysts.

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