Ovarian Cysts: History and Discovery

The story of the ovarian cyst is really two stories braided together. One is the slow, careful work of understanding what the ovary normally does — how it grows a tiny fluid-filled sac each month, releases an egg, and forms a temporary yellow gland afterward. The other is the dramatic and frightening history of the diseased ovary that could swell to enormous size, an old condition once called the “dropsy of the ovary,” and the desperate surgical courage it took to remove one. That surgery — the ovariotomy — was first performed successfully by a country doctor in Kentucky in 1809, on a fully conscious patient, decades before anesthesia or antiseptics existed. From the Graafian follicle of 1672 to the bedside ultrasound of today, this page traces how medicine learned to tell a common, harmless cyst from a dangerous tumor — and why that distinction has saved so many lives.

Table of Contents

  1. What an Ovarian Cyst Is
  2. Regnier de Graaf and the Ovarian Follicle (1672)
  3. The Corpus Luteum: Naming the Yellow Body
  4. “Dropsy of the Ovary” and the Giant Tumor
  5. Ephraim McDowell and the First Ovariotomy (1809)
  6. Spencer Wells and the Taming of the Operation
  7. Dermoid Cysts, Teratomas, and Polycystic Ovaries
  8. Ultrasound and the Modern Era of Diagnosis
  9. Telling Benign Cysts from Ovarian Cancer
  10. Research Papers and References
  11. Connections

What an Ovarian Cyst Is

An ovarian cyst is simply a fluid-filled sac on or within an ovary. The single most important fact in the entire history of this topic — and the one that took medicine centuries to fully appreciate — is that most ovarian cysts are completely normal. They are a side effect of how a healthy ovary works. Every menstrual cycle, the ovary grows a small sac called a follicle to mature and release an egg; that follicle is, by definition, a tiny fluid-filled cyst. When everything proceeds as it should, the follicle ruptures, the egg is released, and the structure left behind reorganizes and dissolves. These ordinary, harmless cysts of the menstrual cycle are called functional cysts, and they are extraordinarily common.

From this normal physiology spring the two most familiar functional cysts. A follicular cyst forms when a follicle grows but does not release its egg and simply keeps filling with fluid. A corpus luteum cyst forms after ovulation, when the structure that should shrink instead seals over and accumulates fluid or blood. Both usually cause no symptoms and quietly disappear over a few weeks or months without any treatment at all. Understanding this benign, self-resolving majority is what allows modern clinicians to reassure most patients rather than rush them toward surgery.

Set against this harmless backdrop are the less common cysts that genuinely matter: dermoid cysts and other tumors, the multiple small follicles seen in polycystic ovaries, endometriosis-related cysts (“chocolate cysts,” or endometriomas), and the relatively rare but serious ovarian cancers. The whole arc of this history is the gradual, hard-won ability to distinguish the ordinary cyst that needs nothing from the dangerous one that needs everything. The sections below follow that arc from the first accurate drawings of the ovary to the imaging that now makes the distinction in minutes.

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Regnier de Graaf and the Ovarian Follicle (1672)

The scientific understanding of the ovary begins with the Dutch physician and anatomist Regnier de Graaf (1641–1673). In 1672, working at Delft, he published a landmark treatise on the female reproductive organs, De Mulierum Organis Generationi Inservientibus Tractatus Novus (“A New Treatise on the Organs of Women that Serve for Generation”). Through meticulous dissection of human and animal specimens, de Graaf described the small, round, fluid-filled bodies embedded in the ovary — the structures we now call follicles. He traced how they enlarged from tiny vesicles into prominent sacs approaching a centimeter across and correctly connected them to reproduction, even reasoning (from his rabbit studies) that each follicle contained the germ of new life. De Mulierum Organis is named here as a historical primary source.

An important point of accuracy: de Graaf did not claim to have discovered these vesicles, and historians are careful to note this. The fluid-filled bodies in the ovary had already been glimpsed by earlier anatomists, including Andreas Vesalius and Gabriele Falloppio in the sixteenth century. De Graaf’s real achievement was the first systematic, detailed account of their development and reproductive role. It was the great physiologist Albrecht von Haller who, in the following century, attached de Graaf’s name to the structure, calling the mature follicle the ovum Graafianum; over time this became the “Graafian vesicle” and finally the Graafian follicle that medical students still learn today.

For the history of ovarian cysts, this matters enormously. The Graafian follicle is a normal, fluid-filled structure — it is, in essence, the physiologic ancestor of the functional cyst. When a follicle grows a little too large or fails to rupture on schedule, what results is a follicular cyst: the very same anatomy de Graaf described, simply persisting longer than usual. In other words, the most common ovarian cyst of all is just an everyday part of the reproductive machinery that de Graaf first mapped in 1672, behaving slightly out of step.

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The Corpus Luteum: Naming the Yellow Body

The ovary’s other great normal structure — and the source of the second common functional cyst — is the corpus luteum, Latin for “yellow body.” After a follicle releases its egg, the empty sac transforms into a small, temporary, yellowish gland that produces the hormone progesterone to prepare the body for a possible pregnancy. If pregnancy does not occur, this gland normally regresses and is reabsorbed. When it instead seals over and fills with fluid or a little blood, the result is a corpus luteum cyst, which, like the follicular cyst, usually resolves on its own.

The naming of this structure is itself a piece of seventeenth-century science. The term corpus luteum is credited to the great Italian microscopist Marcello Malpighi (1628–1694), a founder of microscopic anatomy, who described the yellow body in his studies of the ovary; the work in which the term appears was published posthumously, the Royal Society of London issuing it in 1697. De Graaf, again, had already provided some of the first detailed illustrations of these “globular bodies” in the ovaries of pregnant rabbits, so the discovery and the naming, as so often in this history, belong to more than one person.

Together, the Graafian follicle and the corpus luteum account for the overwhelming majority of ovarian cysts that any woman will ever form. Both were correctly described, in their essentials, before the year 1700 — long before anyone understood the hormones that drive them or could see them in a living patient. It would take the twentieth century’s discovery of estrogen and progesterone, and then ultrasound, to connect these centuries-old anatomical structures to the monthly cycle and to the harmless cysts they so often leave behind.

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“Dropsy of the Ovary” and the Giant Tumor

While anatomists studied the ovary’s normal microscopic structures, physicians faced a far more visible and terrifying problem: ovarian cysts and tumors that could grow to staggering size. An ovary that is normally smaller than a walnut could, over months or years, swell into a cystic mass weighing many pounds — sometimes more than the rest of the patient. Distending the abdomen grotesquely, these masses were historically lumped under the term ovarian dropsy (a “dropsy,” or hydrops, being any abnormal swelling with fluid). To the patient and her physician, the cause was often indistinguishable from advanced pregnancy, severe fluid in the belly, or a fatal abdominal tumor.

Before the nineteenth century, a giant ovarian cyst was very often a death sentence by slow degrees. The mass pressed on the stomach, lungs, and great blood vessels; it caused pain, breathlessness, malnutrition, and immobility. The only interventions available were crude and temporary — most commonly tapping (paracentesis), driving a trocar through the abdominal wall to drain the fluid. Draining relieved the pressure for a time, but the cyst refilled, and repeated tappings invited infection and exhaustion. Opening the abdomen deliberately to remove the cyst was considered almost unthinkable: the belly was regarded as a forbidden cavity, and entering it was widely expected to be fatal from hemorrhage or from the deadly infection then called “peritonitis” or “the surgical fever.”

This was the grim backdrop — no anesthesia, no understanding of germs, no antiseptics, and a near-universal belief that abdominal surgery meant death — against which one frontier physician decided, in 1809, to do the unthinkable and cut a giant ovarian tumor out of a living, conscious woman. That decision opened the entire field of abdominal surgery.

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Ephraim McDowell and the First Ovariotomy (1809)

The dramatic surgical landmark in this history is the ovariotomy — the deliberate removal of a diseased ovary or ovarian cyst — and it belongs to Ephraim McDowell (1771–1830), a surgeon trained at the University of Edinburgh who practiced in the frontier town of Danville, Kentucky. In December 1809 McDowell was called to see Jane Todd Crawford, a woman whose physicians believed her to be long overdue in pregnancy, possibly with twins. McDowell examined her and recognized instead a massive ovarian tumor. He told her plainly that he could offer no certain cure, but that he was willing to attempt to remove it — an operation no one was known to have survived. Crawford agreed and rode some sixty miles on horseback to his home for the attempt.

On 25 December 1809 — Christmas morning — McDowell operated. There was no anesthesia, because anesthesia did not yet exist; ether and chloroform were nearly four decades in the future. There was no antisepsis, because the germ theory of disease was generations away. McDowell made a long incision into the abdomen, reached the enormous cyst, drained and removed the diseased ovary, and closed the wound — a procedure lasting on the order of twenty-five minutes, with Crawford fully conscious throughout, reportedly reciting psalms. The tumor he removed weighed roughly twenty-two pounds (about ten kilograms). Most astonishing of all: Jane Todd Crawford recovered. She convalesced for about a month, rode home, and lived another three decades.

McDowell, a cautious man working far from the medical establishment, did not rush to publish. Only in 1817 did he report his results, in a paper describing three successful cases, “Three Cases of Extirpation of Diseased Ovaria.” The medical world of the day was deeply skeptical that such an operation could be done at all, let alone survived; some openly doubted his account. Yet his work held up, and history has vindicated it. McDowell is remembered as the father of ovariotomy and a founder of abdominal surgery — the first surgeon to prove that the abdomen could be opened deliberately, a major tumor removed, and the patient live. The achievement is documented in the modern medical-historical literature, including a detailed account by Horn and Johnson in the Journal of Clinical Oncology (2010).

It is also honest to record the harder context that recent scholarship has emphasized: McDowell, like other surgeons of the antebellum American South, performed some of his early abdominal operations on enslaved Black women, who could not give meaningful consent. Acknowledging this does not erase the surgical breakthrough, but the history of this lifesaving operation, like much of early surgery, is entangled with the injustice of its time and should be told completely.

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Spencer Wells and the Taming of the Operation

McDowell proved ovariotomy was possible, but for decades it remained a rare and frighteningly dangerous gamble. Many who attempted it lost most of their patients to hemorrhage and to the post-operative infection that killed so reliably that the operation was, at times, condemned outright as reckless. The man who transformed ovariotomy from a desperate rarity into an accepted, survivable operation was the English surgeon Sir Thomas Spencer Wells (1818–1897), working in London in the second half of the nineteenth century.

Wells found ovariotomy a “discredited” operation and rehabilitated it through sheer disciplined volume and careful technique. He performed his first successful ovariotomy in February 1858; when he published his first fifty cases in 1862 the mortality was about 34 percent — appalling by modern standards, yet a marked improvement that, with his meticulous methods, helped win the profession’s acceptance of the operation around 1864. Wells kept refining everything: patient selection, control of the ovarian blood supply, and post-operative care. By 1880 he had performed his one-thousandth ovariotomy, an almost unimaginable experience base for abdominal surgery of that era, with steadily falling death rates.

Crucially, Wells embraced the new antiseptic surgery of Joseph Lister. He adopted Listerian principles — combating the invisible “germs” that caused wound infection — and credited them with much of his improving safety, eventually placing such faith in antisepsis that he changed his entire approach to the wound. Once anesthesia (from the 1840s) removed the agony McDowell’s patient had endured, and antisepsis (from the 1860s–1870s) tamed the lethal infections, ovariotomy became one of the defining operations of modern surgery. The procedure that one frontier doctor had performed on a screaming, conscious woman in 1809 had, within a single lifetime, become a routine and survivable treatment.

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Dermoid Cysts, Teratomas, and Polycystic Ovaries

As surgery and pathology matured, physicians began to recognize that “ovarian cyst” was not one thing but many. Among the strangest is the dermoid cyst, a benign tumor that can contain hair, skin, teeth, and other tissues — the everyday name for a mature cystic teratoma. The word teratoma comes from the Greek teras, meaning “monster,” a name chosen precisely because these tumors could grow such uncanny contents. The term was coined by the towering German pathologist Rudolf Virchow in 1863; the separate term “dermoid cyst” had entered the veterinary literature a little earlier, attributed to Leblanc in 1831. Cases of ovarian tumors containing hair and teeth had in fact been recorded for centuries, but it was nineteenth-century pathology that gave them a coherent name and explanation.

A very different pattern is the polycystic ovary — not one large cyst but many small follicles studding an enlarged ovary, accompanied by hormonal disturbance. The decisive description came in 1935, when the Chicago gynecologists Irving Stein and Michael Leventhal reported a series of seven women who shared a recognizable cluster of features: absent or irregular periods, excess body and facial hair, and enlarged ovaries packed with small cysts. By describing a series rather than isolated cases, they connected what had seemed unrelated symptoms into a single syndrome — long called Stein–Leventhal syndrome and known today as polycystic ovary syndrome (PCOS). They even proposed a treatment, ovarian wedge resection. The fuller history of this condition is told on the dedicated PCOS page; the key point here is that the “cysts” of PCOS are a hormonal phenomenon, distinct from the giant tumors that drove the surgical story.

A third important type is the endometrioma, or “chocolate cyst” — a cyst filled with old, dark blood that forms when endometriosis involves the ovary. Recognizing these different cyst types — functional, dermoid, polycystic, and endometriotic — was essential progress, because each carries a different meaning, a different risk, and a different treatment. A self-resolving follicular cyst and a dermoid teratoma may look superficially similar as “a cyst on the ovary,” but they are entirely different problems, and learning to tell them apart was one of gynecology’s central tasks across the twentieth century.

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Ultrasound and the Modern Era of Diagnosis

For all of recorded history before the mid-twentieth century, a physician could not actually see an ovarian cyst in a living patient. The ovary was hidden deep in the pelvis, and the only ways to assess a mass were to feel the abdomen, to guess from symptoms, or to open the body surgically. This is precisely why so much of the early story is surgical and so often tragic: a benign cyst and a deadly cancer could feel identical from the outside, and the difference might only be discovered on the operating table — or at autopsy.

The revolution came from Glasgow. In 1958, the obstetrician Ian Donald, together with the engineer Tom Brown and the obstetrician John MacVicar, published a paper in The Lancet titled “Investigation of Abdominal Masses by Pulsed Ultrasound,” adapting sonar-like technology — descended from wartime metal-flaw detection — to look inside the human body. Their report explicitly included ovarian cysts among the masses they could now visualize. One famous early case did more than any argument to convince a skeptical profession: a woman believed to have inoperable stomach cancer was shown by ultrasound to have, instead, a large and entirely removable ovarian cyst — and her life was saved.

Ultrasound changed everything about ovarian cysts. For the first time, a clinician could measure a cyst’s size, see whether it was a simple fluid-filled sac or a complex solid mass, and watch a functional cyst harmlessly disappear over a few weeks — all without a single incision. The later development of transvaginal ultrasound brought even sharper detail, and Doppler, CT, and MRI added further ways to characterize a mass. The practical effect was profound: countless women with ordinary functional cysts could now be reassured and monitored rather than operated upon, while the truly worrying masses could be identified and addressed. The centuries-old surgical gamble had finally been replaced, for most patients, by a calm look at a screen.

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Telling Benign Cysts from Ovarian Cancer

If a single thread runs through this entire history, it is the need to separate the harmless from the harmful — and nowhere is that more important than distinguishing a benign functional cyst from ovarian cancer. The two facts must always be held together: ordinary ovarian cysts are extremely common and almost always harmless, while ovarian cancer is comparatively uncommon but serious. Ovarian cancer has long been called a “silent” disease because its early symptoms — bloating, abdominal discomfort, feeling full quickly, urinary changes — are vague and easily mistaken for everyday complaints, which is exactly why telling the two apart has been so difficult historically.

Modern medicine assembles several clues. Age matters greatly: functional cysts are typical in those of reproductive age, whereas a new ovarian mass after menopause warrants more concern, since the menstrual cycle that produces functional cysts has stopped. Imaging features matter: a simple, thin-walled, fluid-only cyst is reassuring, while a complex mass with solid parts, thick walls, or internal blood flow raises suspicion. Blood tests such as CA-125 can add information, though they are imperfect and can be misleading. No single test is definitive; clinicians weigh the whole picture, and major medical bodies have published structured systems to estimate the risk that a given mass is malignant.

The honest, reassuring takeaway from this long history is that the great majority of ovarian cysts are benign and many require nothing more than watchful waiting. But because the stakes of missing a cancer are so high, any persistent ovarian mass — particularly after menopause — deserves proper medical evaluation, and persistent bloating, pelvic or abdominal pain, early fullness, or urinary changes should be discussed with a clinician rather than dismissed. This page is historical and educational and is not a substitute for individual medical advice. For the practical, present-day picture of types, symptoms, and management, see the main Ovarian Cysts article.

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Research Papers and References

The list below combines key peer-reviewed historical and clinical references with curated PubMed topic-search links into the broader literature on the history of the ovary, ovariotomy, and ovarian cysts. Historical primary texts — de Graaf’s De Mulierum Organis (1672), Malpighi’s description of the corpus luteum, and McDowell’s “Three Cases of Extirpation of Diseased Ovaria” (1817) — are named in the article as historical sources rather than as modern citations. Each link opens in a new tab.

  1. Horn L, Johnson DH. Ephraim McDowell, the first ovariotomy, and the birth of abdominal surgery. Journal of Clinical Oncology. 2010;28(7):1262-1268. — doi:10.1200/JCO.2009.25.7261 (PMID: 20124170)
  2. Ikard RW. Ephraim McDowell’s Ovariotomy on General Overton’s Wife. The American Surgeon. 2016;82(4):291-294. — PubMed: PMID 27097619
  3. Azziz R, Adashi EY. Stein and Leventhal: 80 years on. American Journal of Obstetrics and Gynecology. 2016;214(2):247.e1-247.e11. — doi:10.1016/j.ajog.2015.12.013 (PMID: 26704896)
  4. Adashi EY, Cibula D, Peterson M, Azziz R. The polycystic ovary syndrome: the first 150 years of study. F&S Reports. 2022;4(1):2-18. — doi:10.1016/j.xfre.2022.12.002 (PMID: 36959968)
  5. Regnier de Graaf (1641–1673), De Mulierum Organis, and the Graafian follicle — PubMed: de Graaf and the Graafian follicle (history)
  6. Marcello Malpighi and the naming of the corpus luteum (“yellow body”) — PubMed: corpus luteum history
  7. History of ovariotomy and the birth of abdominal surgery — PubMed: ovariotomy history
  8. Sir Thomas Spencer Wells, ovariotomy, and Listerian antisepsis — PubMed: Spencer Wells and ovariotomy
  9. Rudolf Virchow, teratoma, and the ovarian dermoid cyst — PubMed: ovarian dermoid cyst and teratoma (history)
  10. Ian Donald and the first diagnostic ultrasound of pelvic and ovarian masses — PubMed: Ian Donald and obstetric ultrasound (history)
  11. Functional ovarian cysts — follicular and corpus luteum cysts — PubMed: functional ovarian cysts
  12. Ultrasound evaluation and risk stratification of ovarian masses — PubMed: ultrasound and ovarian-mass risk
  13. Distinguishing benign ovarian cysts from ovarian cancer — PubMed: benign cyst vs. ovarian cancer
  14. Ovarian endometrioma (“chocolate cyst”) and endometriosis of the ovary — PubMed: ovarian endometrioma

External Authoritative Resources

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Connections

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