If you have a hard, hard pack in the perineal area, consider a possible vestibular gland cyst, vulvar boil, hematoma, or acromegaly. Vestibular gland cysts, also known as Bartholin’s gland cysts, are caused by the accumulation of secretions from blocked gland ducts and can become infected and purulent in severe cases. Large ones can be similar to walnuts and can be surgically removed. A vulvar boil starts to be painful at the beginning, and in severe cases it may be accompanied by fever and difficulty walking. The skin around the boil will be red and swollen, and can be disinfected with iodophor and erythromycin ointment. The majority of the hematomas are accompanied by a history of trauma and require incision and drainage when they are soft and progressing quickly.