Definition

A nabothian cyst is a small mucus-filled bump on the surface of the cervix (the lower part of the uterus) or the cervical canal. Also known as a mucinous retention cyst or epithelial cyst, the cervix is located at the lower part of the uterus, just above the vagina, and is about 2.5 cm in length.

This type of cyst is benign and commonly found in women of reproductive age. It is not life-threatening and is not malignant.

Nabothian cysts are different from cervical cancer, even though both occur in the cervix. Unlike cervical cancer, nabothian cysts are harmless and do not require treatment. A rare form of cancer called adenoma malignum can appear similar to a nabothian cyst.

Causes

The cervix is surrounded by glands and cells that produce mucus. These glands can become covered by a type of skin cell called squamous epithelium. When this happens, mucus production builds up and blocks the gland, leading to the formation of a smooth, round bump on the cervix known as a nabothian cyst.

This mechanism can occur when the cervix experiences:

• Chronic inflammation (long-term inflammation of the cervix)
• Injury to the cervix
• As part of a normal process

Risk Factor

Any woman with a cervix can develop nabothian cysts, though they are more common during pregnancy or reproductive years. The reproductive age spans from puberty to menopause, typically starting in adolescence and ending in the late 40s or early 50s.

Certain events can influence the growth of skin cells in the cervix, increasing the likelihood of gland blockage and cyst formation. These events include:

• Childbirth. Many women discover nabothian cysts during routine post-pregnancy exams. After childbirth, cervical skin cells grow rapidly, which can block glands and cause cysts.
• Cervical injury. Damage to the cervix, possibly from frequent intercourse, the use of sex toys, or injury during exams, can prompt skin cells to grow and block glands, leading to cyst formation.
• Cervical inflammation or infection. The cervix replaces damaged cells after inflammation or infection, which can block glands and create nabothian cysts. Chronic cervicitis is often associated with this condition.

If you want to know more about inflammation of the cervix, you can read it here: Cervicitis - Definition, Cause, Symptom, and Treatment.

Symptoms

Each nabothian cyst appears as a small, raised, white bump, and there may be more than one. Nabothian cysts typically do not cause symptoms and are often found incidentally during a colposcopy.

Large or multiple cysts can enlarge the cervix, leading to symptoms such as:

• Pain during sexual intercourse
• Pelvic pain
• Vaginal bleeding
• Vaginal discharge

Additionally, large cysts might cause pressure symptoms if they press on nearby organs, such as:

• Abnormal bowel movements
• Incomplete bowel movements
• Difficulty urinating
• Absence of menstruation
• Lower abdominal pain

If a cyst ruptures, it may release mucus and a small amount of blood, perceived as vaginal discharge. This discharge may have an unpleasant odor, but the symptom is usually short-lived. If these symptoms persist, it's advisable to consult a doctor for further evaluation.

Diagnosis

Transvaginal Ultrasound

During a pelvic exam, a doctor might observe small, soft, round bumps (or a cluster of bumps) on the cervix's surface. Most nabothian cysts are small, with a diameter of 0.2 to 0.3 cm. They can be larger, though rarely exceeding 4 cm. These cysts can be detected via a transvaginal ultrasound. If your doctor identifies nabothian cysts during an ultrasound, there is no need for concern as their presence is normal.

Colposcopy

In rare cases, a colposcopy, which involves examining the cervix under magnification, might be needed to distinguish nabothian cysts from other cervical lumps. Large or complex cysts might be misdiagnosed as cancer or tumors due to their appearance. In such cases, MRI can assist in confirming a nabothian cyst diagnosis.

MRI

MRI can help differentiate between cysts and tumors and between normal and abnormal conditions. If cancer is suspected and cannot be distinguished via MRI, further tests like biopsy, conization, and endocervical curettage may be recommended.

However, in cases where the cervical cyst is very large and indistinguishable from malignancy, other techniques like laparotomy or hysterectomy (removal of the uterus) may be necessary.

Management

No treatment is needed for nabothian cysts, as they usually do not cause problems and are not malignant. However, if symptoms like pain are present, further evaluation and treatment might be necessary, as the issue might not just be a nabothian cyst, or complications could be present.

If required, treatment typically involves draining the cyst. Aggressive surgery is avoided due to the risk of scarring, which could later cause pain.

Common treatment options include:

• Electrocautery ablation. In this procedure, a doctor uses electrical currents to remove the cyst. The electric current generates heat that is applied to the cyst. This procedure is recommended because it causes minimal bleeding.
• Cryotherapy. This involves using liquid nitrogen to freeze and destroy the cyst.

These procedures can be performed in a clinic, and you should feel comfortable a few days afterward.

In cases where the cyst obstructs the birth canal or complicates a Pap smear, simple drainage might be performed to allow for normal delivery. If the diagnosis is unclear, or if the cyst is large, deep, and symptomatic, it may be necessary to remove the cyst for laboratory examination to rule out other cervical tumors and adenoma malignum.

Complications

Nabothian cysts are benign and typically do not cause issues. However, numerous or large cysts that fill the cervix can:

• Obstruct the birthing process
• Press on the rectum
• Cause abnormal uterine bleeding
• Block urine flow by compressing the bladder outlet or pressing on nerves controlling the bladder muscles
• Make it difficult for doctors to perform Pap tests or pelvic exams

However, such cysts are rare.

Prevention

There is no specific prevention for nabothian cysts. However, if you have them, there's no need to worry. Instead of focusing on preventing these cysts, it's better to concentrate on detecting more concerning abnormalities through regular check-ups with your gynecologist.

When to See a Doctor?

You should consult a doctor if you experience:

• Vaginal bleeding outside of your menstrual cycle
• Foul-smelling or discolored vaginal discharge
• Pelvic pain

These symptoms could indicate an infection or another condition requiring a doctor's evaluation.

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