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When my doctor asked how it was that I had failed to notice something the size of a grapefruit balancing precariously next to my ovary, I told her it felt the same as growing taller.

I was diagnosed with an ovarian cyst on my first visit to a gynecologist. I was 19 years old and terrified. They told me it was big (about four inches around when they finally took it out), so big that it required invasive surgery. They added, somewhat apologetically, that if it was found sooner and smaller, a laser could have severed the cyst in a neat, quick, outpatient sort of way.

How could I have missed this? I was an intelligent, active college student in September and by October was going in for sonograms that murkily revealed a good-sized round mass perched among what were ominously referred to in high school health class as my "reproductive organs." My periods were heavy, but I just figured that was my bad luck, not my bad health problem. It is likely the cyst had been growing for a long time at a pace too slow to notice. (Even doctor's miss them. This AP headline says it all: "Lawsuit accuses doctor of missing 42-pound ovarian cyst.")

But now it had to go, and somewhat quickly.

What I leaned from talking to others was that cysts are incredibly common. Almost every woman I know either has a personal experience to share or is acquainted with someone else who does. My mass was freaky only for its size and had I been seeing a gynecologist regularly for a few years previous, there's no way it would be that large. With most women, a regular doctor's visit revealed a small cyst that could be lasered out without much pain or discomfort.

Hard data backs up the empirical evidence. The University of Kentucky recently released results of a 15-year study it conducted with 15,000 women over age 50. Nearly 20 percent of those women had cysts. But more than two-thirds of those cysts were smaller than 1.2 inches in diameter, perfect candidates for the laser.



Essentially, an ovarian cyst is nothing more than a fluid-filled sac, like a blister, on an ovary. The ovary forms a follicle that ruptures when the egg is released every month during ovulation. If there is no pregnancy, the follicle dissolves. If it does not dissolve properly, then there's a cyst. Many women have cysts that come and go with their menstrual cycle, unfelt and unnoticed, naturally washed away.

But my case was irregular. According to Kentucky study, only 79 women -- just half of 1 percent in the study -- required traditional surgery because the cyst was large and didn't go away naturally. As with most things, it's the irregularities that cause problems.

There are four types of irregular cysts, which are most often caused by a hormonal imbalance.

Dermoid cyst. This is what I had, and it's gross. The dermoid cyst is formed from confused cells. These cells could have been hair or sweat glands or teeth or bones but instead just freaked out and attached themselves to my ovary. If this sucker had burst, it would have been bad news. As my doctor explained, "the insides are toxic." Happily, he told me that after everything was over.

Endometriosis. Endometrial tissue is what lines the uterus. When that grows outside the uterus, like on the ovary, it can form cysts called endometriomoas. (Though the tissue can grow anywhere in the abdominal cavity.) These cysts are filled with blood and are referred to as "chocolate cysts" because of their color.

Ovarian cystodenoma. These cysts come from cells on the outer surface of the ovary.

Polycystic ovarian disease. Remember the regular, old cysts from before? If there are a lot of them, the ovary will enlarge and its outside will thicken in response. These cysts are most often the cause of fertility problems.

Having a dermoid cyst really freaked me out. Imagine a balloon filled with water … and blood and teeth and hair. It's absolutely repulsive and that's what was in me. My mother, in an ill-advised attempt at humor, nicknamed the cyst my "evil twin." I just called it "fucking gross."

While I felt there was a toxic time bomb inside me waiting to explode, the professionals saw something the size of a grapefruit perched on something the size of an almond that was not a rush job. It had to come out, but we could wait a month or so, until Thanksgiving.

The cyst had other plans. I woke up before my loathed "Social and Legal Aspects of Chemistry" class one day and felt a terrible pain on the right-front side of my abdomen. You know how it's easier to pretend everything is normal when it's not? A less stubborn person would have walked down the hall to wake a friend to take me to the health center. Instead, I went alone.

After an agonizing walk, clutching my sides the whole way, I collapsed in a chair and told the nurse that I was supposed to have a cyst out in a few weeks but it didn't want to wait that long. I was in agony, rating my pain through clamped jaw as an "Eight" on the one to ten scale. The cyst has redefined what hurts and its only side benefit was giving me a high tolerance for pain. If it doesn't hurt that much, it doesn't hurt much at all.







I was admitted to the hospital just a month after my diagnosis. Reading my medical records now, I am comforted to learn that I had "normal external female genitalia" but that my uterus was "slightly pushed to the left." The "pelvic mass" was on my right side, "two finger breadths below the umbilicus." But towards the end, there's hint of doubt and danger: "certainly a possibility of carcinoma has been discussed and entertained."

That's the big scary thing with ovarian cysts - some of them can be cancerous. At 19, would my c-word go from cyst to cancer? Would I lose my ovary? Did I even care? At that point, I was in so much pain it didn't matter, I was simply happy the cyst hadn't burst. The pain, the doctor said, was from "torsion," or "the condition of being twisted or turned." Something had caused the cyst to move around in there and it twisted all around some nerve endings, sending me into a special kind of hell.

The surgeon offered to do a horizontal incision, preserving my ability to wear a bikini but maybe not getting all of the cyst. He was flattering me - scar or not, bikinis aren't my style. I told him to get rid of the damn thing and received a vertical four-inch scar below my navel.

According to the report of operation, "the fallopian tube was draped across" the cyst and that was the cause of the torsion and most of the pain. My right ovary "still had a fair amount of viable ovarian tissue," which meant that it still worked. I lost about 200 ccs of blood, roughly six ounces, or half a can of Coke.

Not bad.

I was in the hospital for four days, much of which was spent inside the short-attention span theater, sponsored by Demerol. And the more research I did, I learned that my operation was pretty much preventable, or at least preventable on that scale.

The key to an ovarian cyst is catching it early. The only way to do that is get regular exams with your friendly, neighborhood gynecologist. If your periods get suddenly heavy, go to the gyn. If you bleed or do anything weird between periods, go to the gyn.

Finding the cyst early makes it much easier to treat. Instead of a grapefruit-sized cyst, you could have a grape, which easily treated with lasers, on an outpatient basis. One friend took the day off after surgery and then headed back to work. That's a whole lot better than the two weeks I spent at my parents' house, unable to drive and climbing the walls.

If you've had an ovarian cyst, it might come back. But the birth control pill, with its uncanny knack for regulating hormones, can keep the cysts away. I'll be on them forever, or at least until I decide whether to have children.

Five years later, my scar's faded, for the most part. It's hard to notice unless, like me, you know it's there. Happily, the brain is incapable of remembering pain, but I remember enough so that I'm hyper-vigilant about going to the gynecologist.

And in between visits, sometimes I wonder if a cyst is armed and growing. Though I stopped getting taller long ago, I like to pretend that I can feel things growing. I'd like to give the doctor a better answer next time. You know, in case it comes up.



Aileen Gallagher, author of three children's books, (and another one, about muckraking, on the way!) writes Weekly Rundown every Friday.