What is a vulval cyst? Who gets vulval cysts? What causes vulval cysts? What are the clinical features of vulval cysts? Explore the different types of vulval cysts and their characteristics.

Understanding Vulval Cysts

A vulval cyst is an encapsulated lesion that contains fluid or semi-fluid material occurring on the external female genitalia. Females of any age can present with a vulval cyst, and the cause can be developmental, genetic, post-traumatic, or spontaneous.

Common Cutaneous Cysts on the Vulva

Milia

Vulval milia are 1–2 mm, white cysts very commonly seen on examination of the labia of older women. They are typically asymptomatic and an incidental finding.

Epidermoid Cyst

Epidermoid cysts are commonly found on the cutaneous aspect of the labia majora of middle-aged and elderly women. They may be solitary or multiple, spontaneous or post-surgical, usually presenting as a painless lump up to a centimetre in diameter.

Cysts Specific to the Vulval Area

Bartholin and Skene Duct Cysts

Cysts of the Bartholin gland or Skene duct contain clear mucoid fluid. Bartholin gland cysts are located towards the back and side of the introitus, while Skene duct cysts are adjacent to the distal urethra. They may present as a lump or as a painful swelling if the cyst has become infected.

Vestibular Mucinous Cyst

Mucinous cysts develop from minor vestibular glands found on the inner labia minora along Hart lines. They typically develop between puberty and the fourth decade and may be found incidentally, present as a palpable lump, or cause pain if the cyst becomes inflamed.

Cyst of the Canal of Nuck

A cyst of the canal of Nuck is a developmental anomaly due to incomplete closure of the round ligament and is the equivalent of a spermatic cord hydrocele in males. It presents as a skin-coloured, asymptomatic swelling located in the inguinal area and labium majorum, resembling an inguinal hernia.

Gartner Cyst

A Gartner, or mesonephric, cyst develops in remnants of an incompletely regressed mesonephric duct. It is a small solitary unilateral cyst on the front vaginal wall towards one side, which may bulge to present as an interlabial mass in late adolescence.

Ciliated Cyst of the Vulva

Remnants of the paramesonephric duct can form a ciliated, or paramesonephric, cyst found incidentally on the labium majorum during pregnancy, puberty, or with other hormonal influences. The lesion is usually a single cyst cavity, 1–3 cm in diameter, and drains clear or amber-coloured fluid if ruptured.

Other Cutaneous Cysts on the Vulva

Eruptive Vellus Hair Cysts

Eruptive vellus hair cysts present as multiple small yellow-brown papules usually on the front of the trunk but have been rarely reported on the labia majora.

Steatocystoma

Steatocystoma is an autosomal dominant skin condition resulting in an abnormal proliferation of the pilosebaceous duct junction. The resultant skin papules drain an oily fluid when punctured. Involvement localised to the vulva has been rarely reported as a late-onset sporadic condition.

Pilonidal Cyst

Pilonidal disease is usually found at the upper end of the gluteal cleft, but has been reported as a painless papule or nodule on the vulva, particularly in the area around the clitoris, due to an ingrown hair forming a dermoid cyst.

Endometriosis

Cutaneous endometriosis can rarely occur on the vulva at the site of previous surgical scars or trauma.

Clinical Presentation of Vulval Cysts

Vulval cysts are dome-shaped, firm or fluctuant, discrete lesions which may be asymptomatic and noticed incidentally, or present due to pain or dyspareunia which may be cyclic, intermittent, or persistent. The location or distribution of the cysts can be characteristic for a particular type of cyst.

Diagnostic Approach

Diagnosis of vulval cysts is usually made by the anatomic location of the cyst. Further investigations such as imaging or aspiration may be required in some cases to confirm the diagnosis and rule out other conditions.

Treatment Options

Treatment options for vulval cysts depend on the type of cyst and the patient’s symptoms. Asymptomatic cysts may not require treatment, while symptomatic cysts may be managed with aspiration, marsupialization, or surgical excision.