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

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • 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 gynaecology 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 (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Vulval disease with suspicion of malignancy (for optimal care patient should be seen within 2 weeks)
  • Unexplained vulval lump, ulceration or bleeding (for optimal 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

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

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

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)


Essential referral information for Vulva lesion / lump / genital warts / boil / swelling / abscess / ulcer / Bartholin’s cyst referrals (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

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Vulva lesion / lump / genital warts / boil / swelling / abscess / ulcer / Bartholin’s cyst referrals

  • 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)


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

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 23 February 2024