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

Emergency referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Vulval disease with suspicion of malignancy
Unexplained vulval lump, ulceration or bleeding
Postmenopausal women with abnormal vulval lesions
Pregnant or immunosuppressed

Category 2

Appointment within 90 days is desirable

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 days is desirable

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

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

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

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available

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.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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 the referral is for genital warts

Additional referral information (useful for processing the referral)

Body mass index (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)

Out of catchment

Metro North 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 North 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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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