Makindo Medical Notes

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

• Macleod’s Clinical Examination
• Patient UK: Bartholin’s cyst/abscess
• Cancer Research UK: Vulval Cancer