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10. A 24-year-old travel agent comes to your clinic, complaining of pain and swelling in her vulvar area. She states that 2 days earlier she could feel a small tender spot on the left side of her vagina but now it is larger and extremely tender. Her last period was 1 year ago and she is sexually active. She uses the Depo-Provera shot for contraception. She denies any nausea, vomiting, constipation, diarrhea, pain with urination, or fever. Her past medical history is significant for ankle surgery. Her mother is healthy and her father has type 2 diabetes. On examination she appears her stated age and is standing up. She states she cannot sit down without excruciating pain. Her blood pressure, temperature, and pulse are unremarkable. On visualization of her perineum, a large, red, tense swelling is seen to the left of her introitus. Palpation of the mass causes a great deal of pain. What disorder of the vulva is most likely causing her problems? A) Bartholin's gland infection B) Vulvar carcinoma C) Secondary syphilis D) Condylomata acuminata Ans: A Feedback: Bartholin's gland infections cause a red-hot tender abscess at the duct opening to the Bartholin's glands. Gonococci, Chlamydia, and other organisms often cause them. Size is variable; if chronic, the infection can present as a nontender cyst. 11. Which of the following represents metrorrhagia? A) Fewer than 21 days between menses B) Excessive flow C) Infrequent bleeding D) Bleeding between periods Ans: D Feedback: Metrorrhagia is bleeding between periods. Menorrhagia is excessive bleeding with menses, while oligomenorrhea is infrequent menses. Polymenorrhea is menstruation with fewer than 21 days between periods.