Female perineal bulge sensation

Specialty: Nephrology and urology.

• bulge in the female perineum
• posterior or anterior female perineal mass

Why it occurs

• Bartholin gland cyst (obstruction of the posterior vulvovaginal gland duct that generates painless mucous accumulation, palpable as a rounded lump in the posterior introitus)
• Advanced rectocele (descent of the rectum through the posterior vaginal wall that presses towards the posterior perineum)
• Skene's paraurethral gland cyst (benign cystic mass adjacent to the anterior urethra in the upper vulvar introitus)
• Poorly healed postpartum perineal tear with granuloma formation
• Perineal endometriosis (endometrial tissue implants in previous episiotomy scars that increase in size and induce cyclical menstrual pain)

Initial workup

Direct inspection gynecological and perineal examination; ultrasound of perineal soft tissues with a high-frequency transducer; culture of secretions or purulent material if there is spontaneous active drainage; surgical biopsy if persistent atypical suspicious solid mass.

Standard management

• Amoxicillin/Clavulanic — 875/125 mg every 8 hours orally for 7 days, indicated in Bartholin's abscess after surgical incision and drainage with placement of a Word catheter or marsupialization
• Ibuprofen — 400-600 mg every 8 hours PO to control pain and local inflammation
• Sitz baths with warm water intermittently to promote the maturation or drainage of superficial inflammatory processes.