Referral to emergency

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.

  • acute painful enlargement of a Bartholin’s gland/cyst
  • acute trauma including:
    • vulva/vaginal lacerations
    • haematoma and/or
    • penetrating or injuries
    • straddle injuries
  • Bartholin’s abscess

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Women's and Children's Health Network


  • concerns of ‘childhood non-accidental injury’ – refer to Child Protection Services for further information
  • vulval disorders without trial of first-line treatment

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • unexplained vulval lump/ulceration/bleeding
  • immunosuppressed person with vulval lesion

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • vulvovaginitis with failed first-line treatment
  • recurrent vulval infections
  • suspected vulval dystrophy
  • vulval dermatoses, including lichen sclerosus

For more on outpatient referrals, see the general referral information.

All referrals for people less than 16 years of age, or those less than 18 years with intellectual disabilities, complex medical conditions, primary amenorrhea, pubertal delay, or Mullerian anomalies are to be sent to Women’s and Children’s Hospital (WCH).

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the WCH cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical/psychosocial history
  • current medications and allergies
  • onset, duration and course of presenting symptoms:
    • pain
    • swelling
    • pruritus
    • localised lesions, pigmented or non-pigmented lesions
    • vaginal discharge
    • trauma where appropriate
    • medical management to date
  • external vulval examination findings

Sexually active people

Complete a sexually transmitted infection screen, including:

  • human immunodeficiency virus and syphilis serology
  • chlamydia and gonorrhoea which requires:
    • endocervical swab for culture and
    • endocervical polymerase chain reaction (PCR) swab or urine sample

vulval ulceration present

  • wound swab (microscopy, culture and sensitivity)
  • PCR screen for herpes simplex virus and varicella-zoster virus
  • exotic travel history including location, date and length of stay

vulval dermatitis present

  • allergy skin testing results
  • fungal swab if suspicion of candidiasis

Clinical management advice

Vulvovaginitis in paediatric cases is commonly caused by irritants such as bubble baths, infections, worms, or dermatological conditions. Yeast infections are rare before the onset of menstruation. In most cases, these disorders can be effectively managed with first-line therapies provided by a general practitioner.

Lichen Sclerosus (LS) often begins with subtle symptoms, making it challenging to diagnose in its early stages. The most common symptom observed in children with LS is intense itching, which may lead to discomfort and difficulty with daily activities. Children may also experience pain or discomfort while urinating or having bowel movements.

It is important to note that relying solely on antibiotics may not result in complete resolution of Bartholin's cysts, particularly when they are large or recurring. Surgical marsupialisation, a procedure to drain the cyst and prevent future recurrences, may be necessary. Therefore, it is recommended to seek medical advice for accurate diagnosis and treatment.

It is important to consider the possibility of sexual abuse in girls presenting with vulval disorders. Please be aware that any concerns of childhood non-accidental injury should be reported and investigated by Child Protection Services.

Clinical resources

Consumer resources