Vulval/vaginal lump
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 urethra; usually small and asymptomatic.
- ⚪ Epidermoid Cyst: Benign subcutaneous cyst 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: Older women; lump, ulcer, bleeding, or itching.
- 🚩 Vulvar Intraepithelial Neoplasia (VIN): Pre-cancerous, raised/irregular lesion.
- 🦠 Infectious Causes:
- 🔥 Genital Herpes: Painful blisters/ulcers, may initially appear as lumps.
- 🪒 Folliculitis: Inflamed, tender bumps post 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
- 🩺 Inspect vulva/vagina: colour, ulceration, tenderness, consistency, mobility.
- 🧪 Swabs: HSV, bacterial, fungal.
- 🧬 Biopsy: Mandatory if malignancy suspected.
- 🖥️ Ultrasound: For deep or cystic lesions.
📊 Vulval/Vaginal Lumps – Causes, Features & Management
| Category |
Common Causes |
Key Features |
Investigations |
Management |
| ✅ Benign |
Bartholin’s cyst, Skene’s cyst, Epidermoid cyst, Fibroma, Lipoma, Genital warts |
Tender/fluctuant (Bartholin), small/soft (Lipoma), cauliflower-like (warts) |
Clinical exam, sometimes US |
Observation if asymptomatic, incision/drainage or marsupialisation for abscess, excision if large, topical therapies for warts |
| ⚠️ Malignant |
Vulval cancer, VIN |
Persistent lump, irregular, ulcerated, bleeding, older age |
Biopsy, colposcopy, imaging if indicated |
Surgical excision, vulvectomy ± radiotherapy/chemotherapy for invasive cancer |
| 🦠 Infectious |
Genital herpes, Folliculitis, Molluscum contagiosum |
Painful blisters (HSV), inflamed bumps (folliculitis), pearly dome-shaped (molluscum) |
Swabs, clinical exam |
Antivirals (HSV), topical antibiotics (folliculitis), cryotherapy/curettage (molluscum) |
📌 When to Refer
- 🎗️ Suspicion of malignancy → urgent referral & biopsy.
- Recurrent or complex Bartholin’s abscesses.
- Lumps enlarging or persisting despite treatment.
✅ Conclusion
Vulval/vaginal lumps are usually benign 💧🌱, but malignancy must always be considered 🚩. Careful history, examination, and biopsy (if suspicious), along with timely referral, are essential for safe practice and early treatment.
📚 References
