Vulval Swelling

Differential Diagnosis

Common Diagnoses

  • Boils
  • Sebaceous Cysts
  • Viral Warts (Condylomata Acuminata)
  • Bartholin’s Cyst
  • Inguinal Hernia (May Extend Down to Labium Major)

Occasional Diagnoses

  • Varicose Vein, Varicocoele of Vulva
  • Bartholin’s Abscess (Infected Bartholin’s Cyst)
  • Fibroma, Lipoma, Hidradenoma
  • Uterine Prolapse, Cystocoele, Rectocoele, Enterocoele (Hernia of the Pouch of Douglas)
  • Urethral Caruncle (Meatal Prolapse)

Rare Diagnoses

  • Cervical Polyp
  • Carcinoma (95% are Squamous)
  • Endometrioma
  • Hydrocoele of the Canal of Nuck
  • Traumatic Haematoma

Ready Reckoner

Key distinguishing features of the most common diagnoses

BoilSebaceous CystViral WartsBartholin’s CystInguinal Hernia
Central PunctumNoYesNoNoNo

Possible Investigations

  • There are no investigations likely to be performed in primary care: the diagnosis is almost always established by history and examination. If it isn’t, then referral is usually required.

Top Tips

  • Remember that, to many patients, a lump means cancer until proven otherwise. You may only require a cursory glance to reassure yourself that the problem is insignificant – but the patient may interpret your approach as dismissive or inadequate. Ensure that the patient’s anxieties are resolved by adequate examination and explanation.
  • If the lump is not obviously apparent, or is poorly defined, examine the patient standing – this may reveal a hernia, varicocoele or prolapse.
  • A varicocoele of the vulva has a characteristic ‘bag of worms’ feel. It often appears and gets worse during pregnancy.

Red Flags

  • A persistent, ulcerating lump in the vulva must always be referred for biopsy to exclude carcinoma, even though some benign lumps can ulcerate (e.g. hidradenoma).
  • Check for lymphadenopathy: Hard inguinal nodes with a painless lump are highly suggestive of malignancy. The lump can occasionally be a metastasis itself.
  • Women with genital warts may have coexisting sexually transmitted infection – refer to the local GUM clinic for appropriate investigation and, if necessary, contact tracing.

Published: 2nd August 2022 Updated: 10th April 2024

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