A Nabothian cyst is a small, mucus-filled cyst that forms on the surface of the cervix. The cervix is the narrow, neck-like lower part of the uterus that opens into the vagina. Nabothian cysts are extremely common in women of reproductive age, especially those who have had children. They can vary in size from just a couple of millimeters (the size of a pinhead) to, in rare cases, a few centimeters in diameter, and a woman can have one or many of them.

To understand how a Nabothian cyst forms, it is essential to understand the unique anatomy of the cervix and a normal process called squamous metaplasia.

• The cervical surface has two different types of cells. The inside of the cervical canal (the endocervix) is lined with glandular cells that produce mucus. The outside of the cervix that extends into the vagina (the ectocervix) is covered in squamous cells, which are flat, skin-like cells.
• The area where these two cell types meet is called the transformation zone.
• Throughout a woman’s life, particularly after puberty and childbirth, the transformation zone changes. The squamous cells from the outside gradually grow over and replace the glandular cells on the outer surface of the cervix. This is a normal, healthy physiological process.

A helpful analogy is to think of the surface of your cervix as a transitioning landscape. The inner canal is like a lush field of “velvet” (the mucus-producing glandular cells), and the outer part is like smooth “satin” (the squamous cells).

• Throughout a woman’s life, the satin lining naturally and slowly grows over the velvet lining.
• The velvet lining is dotted with thousands of tiny, active mucus glands, like microscopic springs.
• As the new layer of satin “wallpaper” grows over these springs, it can sometimes cover up the opening of a gland before it has had a chance to shut down.
• The gland, now trapped beneath the surface, continues to produce a small amount of mucus, but it has nowhere to go. This trapped mucus collects and forms a small, smooth, harmless bubble under the new wallpaper. This bubble is a Nabothian cyst.

In my experience, many women are surprised to learn they have a Nabothian cyst during a routine pelvic exam, it’s usually harmless and often goes unnoticed.

Nabothian cyst is caused by the blockage of a mucus-producing gland (a Nabothian gland) on the cervix.

This blockage is a direct result of the normal physiological process of squamous metaplasia, as described above. The new layer of skin-like cells grows over the gland opening, trapping the mucus inside. The gland then fills with its own secretions and swells, creating the small, smooth bump that a doctor can see on the surface of the cervix. It is not caused by an infection, STI or underlying disease process. It is simply a benign consequence of the cervix’s normal, lifelong cellular changes.

Patients often tell me they’ve never had symptoms, and I explain that these cysts usually form when normal healing tissue blocks a gland on the cervix after childbirth or minor trauma.

You do not “get” Nabothian cysts in the way you would get an illness. They are not contagious, they are not sexually transmitted, and they are not a sign of any wrongdoing or lack of hygiene. They are a normal part of female anatomy and physiology. Any woman who has a cervix can develop Nabothian cysts.

The factors that can lead to their formation are the same factors that stimulate the normal process of squamous metaplasia in the cervix. These include:

• Childbirth: The process of cervical effacement, dilation, and healing after childbirth is a major stimulus for cellular changes in the transformation zone, making cyst formation very common in women who have had children.
• Chronic Cervicitis: Mild, chronic inflammation of the cervix can also stimulate metaplasia.
• Minor Trauma: Minor trauma or cervical irritation.

Because these cysts are linked to the natural life cycle of the cervix, they are most commonly found in women of reproductive age and are less common in girls before puberty or in post-menopausal women whose cervical glands are less active.

In my experience, women who have had vaginal deliveries or minor cervical injuries are more likely to develop Nabothian cysts, although they may not know until years later.

The single most important thing to know about Nabothian cysts is that in the vast majority of cases, they cause absolutely no signs or symptoms.

• They are not painful.
• They do not cause bleeding or discharge.
• They do not cause discomfort during intercourse.
• They do not affect fertility or pregnancy.

Because they are asymptomatic, most women will never know they have them. A healthcare provider almost always discovers them as an incidental finding during a routine pelvic examination or Pap smear.

On examination, a Nabothian cyst appears as a small, smooth, round bump on the surface of the cervix. They often have a whitish or yellowish appearance and can look translucent, sometimes with tiny blood vessels visible on their surface.

Rare Symptoms

In extremely rare instances, a Nabothian cyst can grow to be very large (several centimeters in diameter). A cyst of this unusual size could potentially cause symptoms such as:

• A feeling of fullness or pressure in the pelvis.
• Difficulty with a Pap smear, as the cyst might block access to the cervical canal.
• Chronic pelvic pain or discomfort during intercourse.

It must be stressed that symptomatic Nabothian cysts are the rare exception, not the rule.

Clinically, I rarely see symptoms related to Nabothian cysts unless they’re unusually large, in which case they might cause mild pressure or spotting.

The diagnosis of a Nabothian cyst is almost always made during a routine clinical examination.

• Pelvic Examination: A doctor or nurse practitioner can diagnose Nabothian cysts simply by visualizing them on the cervix during a pelvic exam with a speculum. Their characteristic appearance as smooth, translucent, round bumps is usually unmistakable to a trained eye.
• Colposcopy: If the appearance of a cyst is unusual, or if there are other concerns about the cervix (such as an abnormal Pap smear result), a doctor may perform a colposcopy. This procedure uses a special magnifying instrument called a colposcope to get a highly magnified view of the cervix. This allows the doctor to confirm that the lesion has the classic benign appearance of a Nabothian cyst and is not something more serious.
• Imaging: Nabothian cysts may also be seen incidentally on imaging studies like a pelvic ultrasound or an MRI that are being performed for other reasons.

The primary goal of “diagnosing” a Nabothian cyst is for the healthcare provider to confidently identify it as a benign finding and to differentiate it from other, rarer cervical lesions that could be serious. An experienced provider can do this with a high degree of accuracy by visual inspection alone, providing immediate reassurance to the patient.

In my experience, a visual exam during a Pap smear or pelvic check is usually all that’s needed to diagnose a Nabothian cyst, additional imaging is rarely necessary.

This is the most reassuring aspect of the condition. For almost all Nabothian cysts, the recommended and correct course of action is no treatment at all.

Because these cysts are benign, harmless, and almost always asymptomatic, they can and should simply be left alone. They do not turn into cancer, they do not cause health problems, and they do not require removal. Once your healthcare provider has identified a bump on your cervix as a Nabothian cyst, you can be confident that it is a normal finding that poses no risk to your health.

Treatment for Rare, Symptomatic Cysts

Only in the extremely rare case that a cyst grows to an exceptionally large size and is directly causing symptoms like significant pain or pressure would a doctor consider removing it. Removal procedures are simple and are typically performed in a doctor’s office.

• Electrocautery or Ablation: A thin probe that uses an electrical current can be used to destroy the cyst tissue.
• Cryotherapy: A probe that uses extreme cold (liquid nitrogen) can be used to freeze and destroy the cyst.
• Excision: A very large cyst can be removed surgically with a scalpel.

These interventions are reserved for highly unusual and exceptional cases. For the millions of women who have common, small, asymptomatic Nabothian cysts, no treatment is necessary.

I often reassure patients that treatment isn’t needed unless the cyst is very large or causing symptoms, most resolve or remain stable on their own.

Discovering that you have a “cyst on your cervix” can be a moment of significant anxiety. However, it is vital to know that Nabothian cysts are an extremely common, normal, and completely harmless gynecological finding. They are not a sign of disease, cancer, or infection, but are simply a benign consequence of the natural and healthy changes that the cervix undergoes throughout a woman’s life. They almost never cause symptoms and do not require any treatment. If you have been told you have a Nabothian cyst, you can be confident that this is a normal finding that requires no further action or worry. It is simply a part of your unique female anatomy.

Cleveland Clinic. (2022). Nabothian Cyst. Retrieved from https://my.clevelandclinic.org/health/diseases/22653-nabothian-cyst

National Institutes of Health, MedlinePlus. (2023). Nabothian cyst. Retrieved from https://medlineplus.gov/ency/article/001514.htm