What are vulval cysts? Who gets vulval cysts? What causes vulval cysts? What are the clinical features of vulval cysts? Common cutaneous cysts on the vulva.

What are Vulval Cysts?

A vulval cyst is an encapsulated lesion that contains fluid or semi-fluid material occurring on the external female genitalia. Vulval cysts can develop from any of the structures normally found in this complex area.

Who Gets Vulval Cysts?

Females of any age can present with a vulval cyst; however, a particular type of cyst may be more common in a specific age group.

What Causes Vulval Cysts?

Vulval cysts can be developmental, genetic, post-traumatic, or spontaneous.

What are the Clinical Features 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.

Common Cutaneous Cysts on the Vulva

Milium

Vulval milia are 1–2 mm, white cysts very commonly seen on examination of the labia of older women. The patient may be aware of the multiple small lumps, but typically they are 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. The cysts may be solitary or multiple, spontaneous or post-surgical, usually presenting as a painless lump up to a centimetre in diameter. Giant epidermoid cyst of the vulva has been described.

Bartholin and Skene Duct Cysts

Cysts of the Bartholin gland or Skene duct contain clear mucoid fluid. Bartholin glands are located towards the back and side of the introitus at the 4 o’clock and 8 o’clock positions. Skene glands are adjacent to the distal urethra. Cysts may present as a lump, or as painful swelling if the cyst has become infected and an abscess has formed. Bartholin duct cysts are reported to affect 2% of adult women at some time in their life. Skene duct cysts can also present in neonates. Diagnosis is usually made by the anatomic location of the cyst.

Vestibular Mucinous Cyst

Mucinous cysts develop from minor vestibular glands found on the inner labia minora along Hart lines. Cysts may be found incidentally, present as a palpable lump noticed by the patient, or cause pain should the cyst become inflamed. Vestibular mucinous cysts typically develop between puberty and the fourth decade.

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. It is usually detected by five years of age.

Gartner Cyst

A Gartner, or mesonephric, cyst develops in remnants of an incompletely regressed mesonephric duct. The mesonephric duct forms the male sexual organs, so should regress completely in the female fetus. Persistent mesonephric duct remnants in a female are usually associated with congenital abnormalities of the metanephric urinary system such as an ectopic ureter, unilateral renal agenesis or hypoplasia. A Gartner cyst 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

At the ninth week of gestation, the paramesonephric duct develops into the fallopian tube. Remnants of this 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.

Cutaneous Cysts that May Occur on the Vulva

Eruptive vellus hair cysts, steatocystoma, pilonidal cyst, and cutaneous endometriosis are other types of cysts that may rarely occur on the vulva.

In summary, vulval cysts can have various causes and clinical presentations, with some types being more common in specific age groups. Proper diagnosis is important for appropriate management.