Introduction:
Benign vaginal lesions are neoplasms that are found in the vagina. The frequency of these lesions is from rare to very rare and can be diagnosed with a pelvic exam and biopsy. These may be small asymptomatic to large lesions that can cause urinary obstruction. Most vaginal neoplasms are benign, but it is advisable to rule out any signs of malignancy. These lesions do not produce any symptoms until they reach a significant size; most lesions are detected during routine examinations. Vaginal neoplasms may be divided into cysts or solid lesions.
What Are Vaginal Cysts?
Cysts are pouches or pockets of tissue that can be filled with pus, air, or fluid. Vaginal cysts are those that form on or under the vaginal lining. Vaginal lesions, cysts, or neoplasms are extremely rare. These are divided into two categories: solid lesions and cystic tumors. These are usually benign, small, and asymptomatic. They are diagnosed through a pelvic examination, and confirmation is done using a biopsy. Although these are benign, checking for any precancerous development is advisable. Proper medical history, pelvic examination, and radiographic investigations are used for diagnosis.
What Are the Symptoms?
Most vaginal lesions do not cause symptoms until they grow in size. A soft lump is found in the vaginal wall or protruding from the vagina. The size of the lesion may range from pea-sized to that of an orange. Symptoms and sizes include:
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Dyspareunia: pain during, before, or after intercourse.
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A Sensation of pressure.
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Obstruction of the vagina.
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Obstruction of the urethra.
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Vaginal bleeding.
What Are the Types of Vaginal Lesions?
Vaginal lesions may be cystic tumors or solid lesions.
Cystic tumors include:
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Gartner’s duct cyst.
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Paramesonephric cyst or Mullerian cyst.
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Inclusion cyst.
Solid benign tumors include:
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Leiomyoma.
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Fibroepithelial polyps.
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Condyloma acuminatum.
Gartner’s Duct Cyst:
Gartner’s duct is a duct that is only present in a fetus in the womb and disappears before birth. However, if this is not entirely absorbed, the fluid may build up and form a Gartner duct cyst.
The incomplete regression of the mesonephric or Wolffian duct during the development of the fetus gives rise to this cyst. In males, these ducts form the epididymis. If these cysts are present, it is found along the lateral aspects of the upper vagina. If the cysts are small and asymptomatic, it does not require treatment. However, regardless of the size, a biopsy should be performed. Larger cysts may extend to the cervix and may require surgical removal.
Bartholin’s Gland Cyst:
Bartholin’s gland is found near the side of the vaginal opening or vaginal lips. If a skin flap grows over this gland, the fluid accumulation can cause a cyst formation. It is generally painless; however, if infected, it can form an abscess.
Paramesonephric Cyst or Mullerian Cysts:
Similar to Gartner’s duct, the paramesonephric duct is part of fetal reproductive system development. In females, these ducts form the fallopian tubes, uterus, and top of the vagina. These ducts may become cystic in adults. They contain mucus and may be found anywhere in the vagina. Large symptomatic cysts are excised, and a biopsy should be performed to confirm the diagnosis.
Inclusion Cyst:
Cysts forming in the vagina due to mucosa trapped in the submucosal are a result of surgical procedures such as episiotomy(incision made in the perineum during childbirth) and colporrhaphy(a surgical procedure done to strengthen the pelvic wall) or trauma, including childbirth, are called inclusion cysts. This is the most common type of vaginal cyst; they may contain keratin and squamous debris, and symptoms develop as it enlarges. In addition, foreign body reactions may occur, causing inflammation around the cyst. Treatment includes excision of the cyst in intact condition and re-establishment of normal epithelium.
Solid Benign Tumors:
Leiomyoma:
These are rare, benign, asymptomatic smooth muscle neoplasms that appear on the anterior (front) wall of the vagina. These are believed to originate from the vaginal smooth muscles or smooth muscles of the bladder or urethra. It depends on estrogen, and if large in size can cause vaginal bleeding, discharge, pain during intercourse, and obstruction in urination. In symptomatic cases, it is surgically removed.
Fibroepithelial Polyps:
These are small polyps that sometimes appear in clusters. They are rare and generally asymptomatic. It may arise due to a local injury which may induce granulation tissue. If they do not cause any symptoms, they do not require treatment. However, since there is a possibility of it enlarging during pregnancy, it may be advisable to surgically remove it (along with the polyp and stalk) if a woman plans on giving birth as they may create complications during pregnancy.
Condyloma Acuminatum:
Lesions caused by human papillomavirus are called condyloma acuminatum. There are more than 100 types of human papillomavirus. These lesions may be seen in the cervix, vulva, or only in the vaginal area. Topical therapy may be used by applying Bichloroacetic or trichloroacetic acid. These may be removed by surgical excision, laser therapy, loop electrical excision, or cauterization. Cryotherapy is not advisable as the depth of thermal injury can not be controlled. Aggressive treatment with laser or cautery may result in distortion and scarring of the vagina.
Endometriosis:
This occurs when the endometrium(tissue that lines the uterus) begins to grow outside the uterus. It may result in the appearance of small cysts. Endometriosis may develop in the vagina at the site of a previous operation(secondary) or as primary implants. If not found in other parts of the pelvis, a biopsy is required for diagnosis. Small lesions may be removed by laser or excision. Large lesions may require laparotomy (incision through the abdomen) for removal.
Other Lesions:
Neurofibromas, mixed cell tumors, hemangiopericytoma, myxoma, granular cell myoblastoma, rhabdomyoma, and benign cystic teratoma are rarely found in the vagina. Fallopian tubes prolapse into the vagina after hysterectomy (surgical removal of the uterus), although uncommon, can be mistaken for adenocarcinoma. Biopsy after surgical removal is done for the confirmation of the diagnosis.
Conclusion:
There are a number of benign vaginal lesions that can be broadly classified as cysts or solid tumors. These lesions may vary in size; unless they are large, they may be asymptomatic and non-problematic. These conditions may be diagnosed in routine pelvic examination and need a biopsy for confirmation. If they are small in size, they usually do not need treatment. Surgical removal, cauterization, and laser are some of the methods used to remove these lesions. Most conditions do not require treatment, but it is best to check for any malignant changes.
