22, F, acute throbbing vulval pain

Question 1

22, F
PC: 24h hx of acute throbbing vulval pain
HPC: left side of vulva excruciating to touch, not helped by analgesia, swelling, no d/c, no urinary symps
Sexual hx: long term boyfriend, no STDs, no STIs, last sex 4/7 ago
PMH: no pregnancies, no derm problems, no topical irritants, no trauma

DIFFERENTIALS

Answer 1

• Bartholin’s abscess
• Other vulval abscess
• STI, particularly genital herpes
• Vulva haematoma – accidental or non-accidental
• Behcets disease – autoimmune and mouth ulcers
• Fixed drug eruption
• Thrush infection
• Contact dermatitis
• Lipoma on labia majora

Question 2

22, F
PC: 24h hx of acute throbbing vulval pain

INVESTIGATIONS

Answer 2

Bedside:
1) VULVAL INSPECTION - abscess visible
2) BIMANUAL + SPECULUM - probably not possible due to pain
3) ABDO EXAM - including check for mouth ulcers and lymphadenopathy
4) BASIC OBS - temp, HR, RR

Question 3

22, F
PC: 24h hx of acute throbbing vulval pain

MANAGEMENT

Answer 3

1) EMERGENCY REFERRAL FOR DRAINAGE AND MARSUPIALISATION
N.B. marsupialisation = excision, edges stitched with interrupted dissolvable suture to maintain patency, stops abscess reforming

2) ANALGESIA

3) WARM BATHS/COMPRESSES

4) ABX COVER