A lump in the vulva

A 29 year old Nigerian woman presented with a history of a swelling in the vulval area of two months' duration. She had no history of pain, tenderness, or vaginal discharge. Her menstrual cycles were regular. Previous cervical smears and gynaecological examination were normal.

On examination, she had a large mass in the right labia. It was painless, non-tender, and fluctuant. It was distending the whole of the labium majus on the right (fig 1).

She had excision biopsy under general anaesthetic, with good results (fig 2).

A Bartholin's abscess is distinguished from a cyst by being acutely painful and tender to palpation and by the presence of erythema and oedema. It was previously thought that the infection was invariably gonococcal, but almost any organism can be responsible. Several studies have been done to characterise the organisms responsible for abscess formation.14 Common aerobic isolates are Neisseria gonorrhoeae, Escherichia coli, Chlamydia