Nabothian cysts are common, non-cancerous bumps typically discovered during a routine pelvic examination. These benign lesions are mucus-filled sacs formed when the openings of the glands lining the cervix become blocked. Because they are prevalent, many people trying to conceive or who are pregnant worry about their reproductive health. This article explores the nature of Nabothian cysts and provides a clear understanding of their relationship to fertility and pregnancy.
Understanding Nabothian Cysts
Nabothian cysts form when the process of cell turnover on the cervix causes a minor disruption. The cervix, which connects the vagina to the uterus, is lined with mucus-producing glands called Nabothian glands. These glands are normally covered by simple columnar epithelium, which is eventually replaced by stratified squamous epithelium in a process known as metaplasia.
When new squamous cells grow over the openings of the mucus glands, they trap the secretions inside. This accumulation causes the gland to swell, forming a smooth, rounded bump on the surface of the cervix. They can vary in size from a few millimeters to four centimeters in diameter. These cysts are common following childbirth or chronic inflammation of the cervix, as these events involve significant tissue change and healing.
Fertility and Pregnancy with Nabothian Cysts
The presence of Nabothian cysts generally does not impede the ability to conceive or carry a pregnancy to term. The cysts typically form on the external surface of the cervix (ectocervix) and are usually small and superficial. Their location and size do not create a physical barrier strong enough to block the cervical canal, which is the pathway sperm must travel to reach the uterus. Therefore, the cysts rarely interfere with the successful transport of sperm toward the egg, and small cysts have no proven effect on conception.
There are rare instances where extremely large or numerous cysts, sometimes classified as “giant” if they exceed four centimeters, might physically obstruct the cervical opening (os). In such scenarios, the cysts could theoretically interfere with sperm passage or complicate procedures like embryo transfer during assisted reproductive technology.
For those who are already pregnant, Nabothian cysts pose no risk to the developing fetus or the health of the mother. They are often found during routine pregnancy examinations and can form during gestation due to hormonal changes. In an isolated, rare case, a massive cyst was reported to block the birth canal during labor, but draining the cyst allowed for a safe vaginal delivery.
Diagnosis and Medical Management
Nabothian cysts are typically discovered during a routine pelvic examination or Pap test, appearing as white or yellow bumps on the cervix. If there is uncertainty about the visual diagnosis, a healthcare provider may use a procedure called a colposcopy, which involves a magnified view of the cervix, to confirm the benign nature of the lesion. Imaging techniques like transvaginal ultrasound or MRI can also characterize the cyst, especially if it is large or complex.
The primary medical focus is ensuring that the lesion is not a more serious condition, such as a cervical polyp or a rare form of cervical cancer. Because these cysts are harmless and asymptomatic for most people, no treatment is needed beyond observation. Intervention is reserved for rare instances when the cysts are unusually large, cause symptoms like excessive discharge or bleeding, or make a necessary examination of the cervix difficult. Treatment, when required, may involve electrocautery or excision to drain or remove the cyst.