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
    • <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.

  • 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)

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