Vulval/vaginal lump

• Bartholin’s Cyst/Abscess: Painful or painless lump in the posterolateral aspect of the vaginal introitus, may become infected and form an abscess.
• Sebaceous Cyst: Painless, small, subcutaneous lump, typically with central punctum.
• Lipoma: Soft, mobile, painless lump, typically slow-growing.
• Fibroma: Firm, well-circumscribed, slow-growing lump, often asymptomatic.
• Cystocele: Prolapse of the bladder into the anterior vaginal wall, causing a bulge, often associated with urinary symptoms.
• Rectocele: Prolapse of the rectum into the posterior vaginal wall, causing a bulge, often associated with bowel symptoms.
• Urethral Diverticulum: Periurethral mass with post-void dribbling, dysuria, or recurrent urinary tract infections.
• Gartner’s Duct Cyst: Remnant of the Wolffian duct, usually found on the anterolateral vaginal wall, typically asymptomatic.
• Vaginal Inclusion Cyst: Post-surgical or post-traumatic cyst, smooth, painless lump in the vaginal wall.

• Genital Herpes: Painful vesicles or ulcers, may present as multiple small lumps before ulceration.
• Syphilis: Painless ulcer (chancre) in primary stage, secondary stage may present with condylomata lata (broad, flat warts).
• Condylomata Acuminata (Genital Warts): Painless, cauliflower-like growths caused by HPV infection.
• Molluscum Contagiosum: Small, pearly, umbilicated papules caused by a poxvirus, often multiple lesions.
• Folliculitis: Inflammation of hair follicles, often presenting as small, tender lumps with possible pustules.
• Hidradenitis Suppurativa: Chronic, painful, inflamed nodules, often in the groin, with sinus tracts and scarring.

• Vulval Squamous Cell Carcinoma: Irregular, often ulcerated mass on the vulva, may be painful or pruritic.
• Melanoma: Pigmented lesion on the vulva, asymmetrical with irregular borders, may be itchy or painful.
• Vulvar Intraepithelial Neoplasia (VIN): Pre-cancerous lesions, may present as red, white, or pigmented plaques or lumps.
• Paget’s Disease of the Vulva: Eczematous, red, scaly lesions on the vulva, may have an underlying adenocarcinoma.
• Vaginal Cancer: Rare, usually presents as an irregular lump, ulcer, or area of induration in the vaginal wall.
• Metastatic Disease: Secondary tumours from primary cancers (e.g., cervical, endometrial, or colorectal cancer), presenting as lumps in the vagina or vulva.

Assess the specific symptoms presented by the patient:

• Onset and Duration: Sudden vs. gradual onset, any changes in size or characteristics over time.
• Pain: Presence of pain, its nature (e.g., burning, throbbing), and relation to activities such as sitting, walking, or intercourse.
• Discharge: Any associated discharge, its nature (e.g., purulent, bloody), and any odour.
• Associated Symptoms: Itching, bleeding, urinary or bowel symptoms, systemic symptoms like fever or malaise.
• Sexual History: Recent sexual activity, history of sexually transmitted infections, use of contraception.
• Trauma: History of recent trauma, including sexual intercourse, or previous surgical procedures.

Gather a detailed background including:

• Past Medical History: Previous episodes of similar lumps, history of skin conditions, autoimmune diseases, or malignancies.
• Drug History: Use of medications, including hormonal contraceptives, immunosuppressants, or recent antibiotics.
• Family History: Family history of skin conditions, autoimmune disorders, or cancers.
• Social History: Smoking status, alcohol use, hygiene practices, recent travel, exposure to new sexual partners, or stressors.

• Inspection of the Vulva/Vagina: Assess for size, shape, colour, and surface characteristics of the lump, any associated discharge or ulceration.
• Palpation: Determine consistency (soft, firm, cystic), mobility, tenderness, and any fixation to underlying structures.
• Speculum Examination: To assess the vaginal walls and cervix for any internal lumps or masses.
• Bimanual Examination: To assess for pelvic masses, tenderness, or other abnormalities in the pelvic organs.
• Lymph Node Examination: Palpate inguinal lymph nodes for enlargement, tenderness, or fixation.
• Systemic Examination: If systemic conditions like hidradenitis suppurativa or metastatic disease are suspected, assess for related findings elsewhere on the body.

• Swabs: For bacterial, viral, or fungal culture if infection is suspected.
• Biopsy: For histological examination, particularly if malignancy, VIN, or other suspicious lesions are present.
• Blood Tests: Full blood count, inflammatory markers (e.g., CRP, ESR), and autoimmune screen if systemic involvement is suspected.
• Ultrasound: Pelvic or transvaginal ultrasound to assess cysts, masses, or other structural abnormalities.
• MRI/CT Scan: For further evaluation of complex masses or to assess for metastatic disease.
• Colposcopy: Detailed examination of the cervix, vagina, and vulva, with guided biopsy if necessary.