Diagnosing Vulvar Bulge and Urinary Issues

The patient presents with two key symptoms:

• A noticeable bulge at the vulva that decreases after urination.
• Difficulty starting the urination process.

These symptoms are characteristic of a condition where pelvic organs descend into the vagina. Let's analyze the options:

Evaluating the Options:

• Uterine prolapse: This involves the uterus descending. While it can cause a bulge, it doesn't typically resolve significantly after urination or primarily cause difficulty initiating voiding.
• Fibroid polyp: This is a growth within the uterus or cervix and is unrelated to bladder function or a fluctuating vulvar bulge related to urination.
• Cystocele: This is the prolapse (descending) of the urinary bladder into the vaginal wall. A cystocele causes a bulge that can feel larger when the bladder is full and smaller after emptying (diminishes after micturition). The prolapsed bladder can also kink or obstruct the urethra, making it difficult to initiate urination. This matches the patient's symptoms precisely.
• Congenital elongation of cervix: This is an anatomical variation of the cervix and does not typically present with these specific urinary symptoms or a fluctuating bulge.

Conclusion:

The combination of a vulvar bulge that lessens after urination and difficulty initiating micturition strongly points towards a Cystocele.