Elderly woman with clitoral swelling and pain

A 77-year-old female presented to our community-based emergency department complaining of clitoral swelling and pain (Figure 1). She reported a 2-week history of gradually increasing enlargement and discomfort of the area. One month prior to the onset of these symptoms, she had undergone a urethral bulking agent injection by a urogynecologist at a different health system to treat urinary stress incontinence with polyacrylamide hydrogel (Bulkamid).¹

She was awaiting a follow-up appointment with her urogynecologist but decided to seek care in the emergency department instead once she felt the pain was no longer tolerable. In the emergency department, point-of-care ultrasound was performed showing a localized collection of heterogeneous nonvascular debris consistent with abscess formation, as opposed to solid or cystic mass (Figure 2 and video file supplemental data).²