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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

Please insert the below information and minimum referral criteria into referral

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

  • BMI
  • 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.

 

Version: 18
Last updated: 07 December 2020

© State of Queensland (Queensland Health) 2021

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au.

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