A 50-year-old female, gravida 2, para 2, presents to the office with vulvar pain. For the past three months, she reports noticing a “walnut” sized bump on the left vulva that has increased in size in the past week. She reports it is tender, and it is difficult to sit for long periods of time. She also reports dyspareunia. She is currently taking ibuprofen for pain and using warm compresses without alleviation of symptoms. She reports similar symptoms on the same side that required incision and drainage, once in her 30s and, more recently, four months ago when a Word catheter was placed. She denies fevers, chills, and nausea/vomiting. Her last menstrual period was two weeks ago and has regular monthly cycles with light bleeding. Past medical history is significant for hypertension, obesity, and hyperlipidemia. Past surgical history is significant for bilateral tubal ligation. She is sexually active with husband of 25 years.