Vulval Swelling

Name: Vulval Swelling - Pulse Reference
Published: 2022-08-02T16:43:41+00:00

Differential Diagnosis

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)

Key distinguishing features of the most common diagnoses

	Boil	Sebaceous Cyst	Viral Warts	Bartholin’s Cyst	Inguinal Hernia
Tender	Yes	No	No	No	No
Reducible	No	No	No	No	Yes
Multiple	Possible	Possible	Yes	No	No
Epidermal	Yes	Yes	Yes	No	No
Central Punctum	No	Yes	No	No	No

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.

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.

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.