Vulval Swelling

Vulval swellings may originate in the vulva, or appear there after displacement from their origin. They often present as ‘a lump down below’ – an expression which belies the variety of possible causes. They generate a lot of anxiety but are rarely sinister.

Published: 2nd August 2022 | Updated: 15th August 2022

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.
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Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.