Gartner’s cyst is a cyst in the upper thirds of the vagina that is thought to be promoted by retained relics of Gartner’s duct. The cysts are relatively large but usually do not cause discomfort. After an incidental finding, cyst resolution is by puncture or surgery.
What is a Gartner cyst?
Cysts are fluid-filled cavities that appear encapsulated and are lined with epithelium. They can occur in just about any tissue and in a wide variety of body sites. For example, one group of cysts is vaginal cysts, which can occur in the vaginal wall. Along with inclusion cysts, Gartner cysts are one of the most important subcategories of vaginal cysts. Gartner cysts have a relatively large shape and arise from embryonic tissue remnants. Most commonly, Gartner cysts are located in the upper two-thirds of the vagina and involve the tissue of Gartner’s duct, the origin of which is the embryonic mesonephric duct or Wolff duct. Gartner’s cyst affects between one and two percent of all women. Age does not play a role in its development. The number of people affected is probably much higher. Because the cysts rarely cause symptoms, they are probably often not recognized. Gartner cysts without an epithelial lining are so-called pseudocysts and thus cannot be called true Gartner cysts.
Causes
The development of a cyst may be related to various causes. As with those in the breast or ovaries, the influence of hormones is discussed as a causative factor for cysts in the vagina. Also under discussion are process disorders and parasites or hereditary connections. So far, it has only been proven that Gartner cysts form from tissue relicts of the Gartner duct. Since this duct corresponds to a relict of the mesonephric duct, disorders during embryonic development may also play a role in a disposition for Gartner cysts. During female embryonic sexual differentiation, the ureteral duct actually gives way completely, leaving only minor remnants. Gartner cysts appear to affect females in whom an area in the lower portion of the urinary meatus is preserved. Nevertheless, the definitive causes of vaginal cysts remain unclear to date. As with all other cysts, a wide variety of correlations and combined factors are conceivable. Both external and genetic factors may play a role.
Symptoms, complaints, and signs
The clear majority of all vaginal cysts are completely asymptomatic. Because the Gartner cyst corresponds to a relatively large cyst, patients may be able to palpate it. Patients usually describe the palpable finding as a bulging and elastic bulge into the vaginal lumen. All other symptoms depend primarily on the exact size of the Gartner cyst. If symptoms exist at all, in most cases they are absolutely non-specific. For example, a severely bulging vaginal wall can interfere with sexual life. Some patients describe pain during sexual intercourse. Others are much more frequently affected by inflammation of the bladder. This phenomenon can be explained by the fact that large Gartner cysts, depending on their exact location, may accumulate bacteria. These can be pushed into the urinary tract and bladder and cause inflammation there. In most cases, however, patients do not visit the doctor because of complaints that have arisen in the context of the Gartner cyst. Often they are even disturbed by the findings because of the absolute asymptomatic nature of the phenomenon. Only in absolute isolated cases Gartner cysts burst before they are even noticed. In this case, severe pain and bleeding may develop.
Diagnosis
In most cases, the Gartner cyst is an incidental gynecologic finding. To confirm the suspected diagnosis of a vaginal cyst and identify the cyst as a Gartner cyst, an MRI is used. Gartner cysts have high signal intensity on T2-weighted MRI image sequences and have either low or intermediate signal intensity on T1-weighted MRI sequences. In individual cases, signal intensity depends on the protein content of the cyst interior. Cyst puncture clarifies the question of benignity of the detected abnormalities. The fluid from the cyst is sent to the laboratory for histological examination.Gartner cysts are associated with a favorable prognosis and are not prone to degeneration.
Complications
In most cases, Gartner cyst does not cause complications or discomfort. In most cases, it is also not noticed because there is no pain or other discomfort. The patient may be able to palpate the Gartner cyst and have an examination performed for this reason. Often, therefore, the cyst is diagnosed at an early stage so that treatment can be given immediately. Due to the strong bulge, in many cases there is pain during sexual intercourse. This can also negatively affect the other partner and lead to psychological discomfort. In severe cases, it can also lead to inflammation of the bladder, which is painful and in the worst case can lead to insufficiency. As a rule, the Gartner cyst is treated before it bursts. Treatment only needs to take place if the cyst is malignant and therefore needs to be removed. Removal usually proceeds without complications. Benign cysts are not removed in most cases and disappear on their own. Surgical interventions are also used in cases of pain. Life expectancy is not reduced by the Gartner cyst.
When should you see a doctor?
Because the Gartner cyst is often completely asymptomatic to the patient, in most cases it is not detected until a routine examination. It is generally advisable to participate in the control examinations offered in order to be able to detect and treat diseases at an early stage. If symptoms develop beyond this, a doctor should also be consulted outside the annual gynecological examination. A visit to the doctor is advisable in the case of general malaise, a diffuse feeling that something might be wrong or sexual disorders. If there is an unusual discharge from the vagina or if the usual body odor of the intimate area changes, the observations should be discussed with a doctor. A purulent discharge indicates diseases that need to be treated. If there are irregularities in menstruation, pain during the sexual act, or changes in libido, a doctor is needed. A visit to the doctor is also necessary if irregularities are noticed by your own palpation of the vaginal canal or cervix. If there are symptoms of inflammation of the bladder, general irritability or unusual bleeding, a doctor should be consulted. If there is pain or a feeling of pressure in the abdomen, consultation with a doctor is also necessary. In rare cases, itching or an inner restlessness sets in. With these indications, the affected person should present to a doctor if they persist for several weeks.
Treatment and therapy
Treatment is not mandatory for a benign and asymptomatic Gartner cyst. In many cases, cysts regress on their own. For this reason, for example, waiting may be advisable before an intervention. Regular check-ups should at least take place during this time. If the cyst causes discomfort, it should be removed without further waiting. Removal of a Gartner cyst can be a minimally invasive procedure. Puncturing the cyst, for example, can drain the containing fluid. Ideally, the cyst will regress thereafter. If recurrence occurs and the encapsulation fills with fluid again, minor surgery takes place. Surgery is also considered the treatment of choice for painful Gartner cysts. During the surgical procedure, the cyst can be completely removed. This excludes the possibility that it will fill with fluid again after some time. If the patient refuses surgery despite a recurrent Gartner cyst, she should at least attend regular check-ups. Although the risk of degeneration in Gartner cyst is rather low, degeneration cannot be completely excluded.
Outlook and prognosis
Overall, the prognosis of a Gartner cyst is favorable. Often, the benign tissue changes do not lead to any impairment and remain unnoticed by the affected person. Incidental findings lead to a diagnosis that does not always result in treatment. Since the Gartner cyst can increase in size, there is still the possibility of feelings of tightness or interference with sexual activities at any time.Although the growth of the cyst may cause various complaints, the prognosis in these cases does not change. It remains good. If the doctor and patient decide to remove the cyst, the usual complications may occur. Surgical intervention is basically associated with risks, which can occur even with local anesthesia. After successful removal and wound healing, the patient is automatically free of symptoms. Nevertheless, a Gartner cyst may develop again in the course of life. The prognosis remains favorable if the tissue change develops again. In rare cases, the disease progresses to malignancy. The cyst mutates and cancer cells spread throughout the body. This leads to a worsening of the prognosis. The sooner a diagnosis can be made and treatment is initiated, the better the chances of cure. Without medical care, there is a risk of premature death.
Prevention
Gartner cysts are likely to develop whenever large portions of the Gartner duct are retained. In some circumstances, removal of Gartner duct relics prevents Gartner cysts.
Follow-up
With a Gartner cyst, the affected person has very limited options for follow-up care. In this case, the patient is primarily dependent on treatment and removal of this cyst to prevent further complications. In general, early diagnosis and early treatment have a positive effect on the course of this disease and can prevent further complaints. The earlier the Gartner’s cyst is detected, the better the further course of this disease usually is. In most cases, the Gartner cyst is removed by surgery. After such an operation, the patient should always rest and take care of the body. The patient should refrain from exertion or other stressful activities in order to avoid unnecessary strain on the body. In many cases, further follow-up examinations are also necessary to guarantee complete healing of the Gartner cyst. Regular examinations after a successful procedure may also be useful in this regard. If degeneration has occurred as a result of the Gartner cyst, the entire body must be examined for the presence of tumors. In most cases, this disease does not reduce the life expectancy of those affected.
This is what you can do yourself
A benign and asymptomatic Gartner cyst does not necessarily need to be treated by a doctor. In most cases, it is sufficient if the affected person takes care of adequate intimate hygiene and ensures that the cyst does not enlarge. However, if symptoms or serious complications occur, the gynecologist must be consulted. Accompanying medical treatment, various measures can then be taken, depending on the symptoms. In the case of cystitis, warmth and plenty of sleep help. Pain can be relieved by medicinal herbs from nature, but also by warm compresses or a hot bath with essential additives. Accompanying this, it must be decided together with the doctor whether the cyst should be removed. Surgical removal of the cyst is unproblematic and does not require any special preparation by the patient. However, it is recommended not to take any stimulants before the operation and otherwise to follow the instructions of the doctor in charge. After the operation, the patient should take a sick leave for a few days. After that, bed rest and rest is indicated. In addition, the site of the procedure should be well observed and examined once a week by a gynecologist, as this is the only way to rule out complications without any doubt.
