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Vulva lesion/ lump/genital warts/ boil/ swelling/ abscess/ ulcer/ Bartholin’s cyst

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Acute urinary obstruction
  • Unstable molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology

 

  • Refer to HealthPathways and or local guidelines
  • For paediatric and adolescent gynaecology patients, please refer to statewide paediatric and adolescent gynaecology (SPAG) services at Queensland Children's Hospital/RBWH
    • <14 years refer to Queensland Children's Hospital
    • >14 years refer to RBWH or local adolescent gyane service
  • Antibiotic treatment of Bartholins cyst is of no value. 
  • In women where a vulval cancer is strongly suspected on examination, urgent referral should not await biopsy.
  • Vulval cancers may present as unexplained lumps, bleeding from ulceration or pain. 
  • Vulval cancer may also present with pruritus or pain. For a patient who presents with these symptoms and where cancer is not immediately suspected, it is reasonable to use a period of ‘treat, watch and wait’ as a method of management. However, this should include active follow-up until symptoms resolve or a diagnosis is confirmed. If symptoms persist, the referral may be urgent or non-urgent, depending on the symptoms and the degree of concern about cancer. 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)

     

    • Vulval disease with suspicion of malignancy. For optimum care, patient should be seen within 2 weeks.   
    • Unexplained vulval lump, ulceration or bleeding. For optimum care, patient should be seen within 2 weeks. 
    • Postmenopausal women with abnormal vulval lesions
    • Pregnant or immunosuppressed

     

  • Category 2
    (appointment within 90 calendar days)
    • Suspected vulval dystrophy
    • Bartholin’s cysts or other vulval  cysts in patients >40 years old
    • Vulval warts where:
      • the patient is immunocompromised (e.g. HIV positive, immunosuppressant medications)
      • the diagnosis is unclear
      • atypical genital warts (including pigmented lesions)
      • there are positive results from the screen for other STIs
  • Category 3
    (appointment within 365 calendar days)
    • Vulval lesion where:
      • there is treatment failure or where treatment cannot be tolerated due to side-effects
      • there are problematic recurrences
    • Vulval rashes
    • Vulval warts
    • Bartholin’s cyst/labial cysts

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

 

2. Essential referral information Referral will be returned without this

  • History of:
    • pain
    • swelling
    • pruritus
    • dyspareunia
    • localised lesions (pigmented or non-pigmented lesions)
    • STIs or other vaginal infections
    • local trauma
  • Elicit onset, duration and course of presenting symptoms
  • Date of last menstrual period
  • Medical management to date
  • Cervical screening if referral for warts

3. Additional referral information Useful for processing the referral

  • Vulva ulcers swab M/C/S and viral PCR result
  • Vulval rashes scraping, swabs or biopsy (as appropriate)
  • STI screen result -endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA (as appropriate)
  • Syphillis HIV serology (as appropriate)

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body Mass Index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.