Vaginal wall cysts tend to be embryologic in nature and often asymptomatic. These cysts include Gartner’s duct cysts, Müllerian cysts, epithelial inclusion cysts (ectopic epithelium), urethral diverticula, and cysts resulting from a blocked gland Bartholin duct cyst) or obstructed Müllerian duct anomaly. A complete vaginal septum will typically be diagnosed during menarche when a hematometra develops from the obstructed menstrual flow (see Hematometra and Hematocolpos). Gartner’s duct cysts are remnants of the mesonephric ducts and are most often discovered incidentally. They are located along the anterolateral aspect of the vagina and are typically clear unilocular cysts. Bartholin’s glands are mucus-secreting glands in the posterolateral aspect of the vaginal opening, near the rectum. Bartholin’s duct cysts result from blockage of the duct and swelling from accumulated secretions.

Fibroids may occur in the vagina, originating from the smooth muscle cells of the anterior vagina or vesicovaginal septum. These are usually solid rounded masses that are well encapsulated and not particularly vascular. Implants of endometriosis are commonly found in the rectovaginal septum or along the posterior wall of the bladder, and may indent or involve the vaginal wall. Malignant masses in the vagina are very rare. Metastatic spread (such as lymphoma or melanoma) accounts for the most common malignant masses in the vagina, followed by primary squamous cell carcinoma. Primary vaginal cancers represent only 1% to 2% of all gynecologic malignancies, and 85% of these primary vaginal malignancies are squamous cell carcinoma. Other rare primary vaginal cancers include adenocarcinoma, melanoma, lymphoma, and sarcomas.