A vulval or vaginal lump is a common gynecological presentation. Causes range from benign cysts to malignancy. Careful assessment is essential to provide the correct treatment and to rule out cancer. 🧠 Early recognition of “red flag” features (persistent, irregular, ulcerated, or painful lesions) is crucial.

🌸 Common Causes of Vulval/Vaginal Lumps

✅ Benign Causes:
- 💧 Bartholin's Cyst: Swelling due to duct blockage; abscess if infected (tender, fluctuant).
- 💧 Skene’s Duct Cyst: Near the urethra; usually small.
- ⚪ Epidermoid Cyst: Benign, under the skin, from blocked sebaceous glands.
- 🧵 Fibroma: Firm fibrous lump.
- 🥑 Lipoma: Soft fatty lump in vulval area.
- 🌱 Genital Warts (HPV): Multiple, flesh-coloured, cauliflower-like lumps.
⚠️ Malignant Causes:
- 🎗️ Vulval Cancer: Usually in older women, may present with a lump, ulcer, bleeding, or itching.
- 🚩 Vulvar Intraepithelial Neoplasia (VIN): Pre-cancerous, raised or irregular lesion.
🦠 Infectious Causes:
- 🔥 Genital Herpes: Painful blisters/ulcers, may appear as lumps first.
- 🪒 Folliculitis: Inflamed, tender bumps after shaving/waxing.
- ⚪ Molluscum Contagiosum: Small, pearly, dome-shaped bumps with central dimple.

🧾 Diagnosis

Diagnosis is based on history + examination, supported by tests when necessary. Always consider malignancy until ruled out. 🎗️

📝 Key Aspects of History

Onset, duration, and growth of lump.
Symptoms: pain, itching, discharge, bleeding.
Sexual history: previous STIs, HPV exposure.
History of trauma, surgery, shaving/waxing.
Family history of cancer.

👩‍⚕️ Examination & Investigations

🩺 Examination: Inspect vulva/vagina → colour, ulceration, tenderness, consistency, mobility.
🧪 Swabs: For infection (HSV, bacterial, fungal).
🧬 Biopsy: Mandatory if malignancy suspected.
🖥️ Ultrasound: For deep or cystic lesions.

💊 Management

💧 Bartholin’s Cyst/Abscess: Small asymptomatic → observe. Abscess → incision & drainage. Recurrent → marsupialisation. Antibiotics if infected.
💧 Skene’s Duct Cyst: Excision if symptomatic.
⚪ Epidermoid Cyst: Excision if large or infected.
🌱 Genital Warts (HPV): Imiquimod/podophyllotoxin, cryotherapy, or excision.
🎗️ Vulval Cancer: Surgical excision/vulvectomy ± radiotherapy/chemotherapy.
🔥 Genital Herpes: Antivirals (acyclovir). Supportive care for recurrences.
⚪ Molluscum Contagiosum: Often self-limiting; cryotherapy/curettage if persistent.
🪒 Folliculitis: Improve hygiene, avoid tight clothing, topical antibiotics if needed.

📌 When to Refer

🎗️ Suspicion of malignancy → urgent referral, biopsy required.
Recurrent or complex Bartholin’s abscesses.
Lumps enlarging or persisting despite treatment.

✅ Conclusion

Vulval/vaginal lumps have many benign causes, but malignancy must always be considered 🚩. Careful history, examination, biopsy (if suspicious), and timely referral are essential for safe practice.

📚 References

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Vulval/vaginal lump