Introduction: Labial masses are common in OBGYN clinics. They are benign the vast majority of times. Common causes are Bartholin cysts, epidermal inclusion cysts, labial warts, sebaceous cyst. We report a case of a 33 year old who presented for what appeared to be a benign Bartholin gland cyst but resulted in massive hemorrhage, exam under anesthesia, massive transfusion, and embolization. Case Summary: A 33 year old patient presents for a painless, non-enlarging labial mass that has been present for 3 weeks. History and physical exam were consistent with a commonly encountered condition, Bartholin gland cyst. Routine incision and drainage of this mass led to massive hemorrhage. The patient was emergently transferred to the operating room for an exam under anesthesia. The patient lost approximately 2 liters of blood in 15 minutes during transit to the operating room. Bleeding was controlled intraoperatively and the mass was found to be an arteriovenous malformation. The patient was stabilized and transferred to the ICU. Subsequently she underwent pudendal artery embolization with interventional radiology. Conclusion: Arteriovenous malformations (AVMs) are a grouping of poorly formed arteries and veins that connect to each other without a capillary bed. The prevalence of AVMs is rare and occur in less than 1% of the population, and pelvic AVMs account for 2% of those instances. Pelvic AVMs can present with pelvic pain, abdominal pain, abnormal vaginal bleeding, tenesmus, etc, although 20% are asymptomatic and they do not become symptomatic until they grow into other tissues. The majority of Pelvic AVMs occur in the context of congenital conditions such as Hereditary hemorrhagic telangiectasia, Cowden syndrome from PTEN mutations, Parkes Weber syndrome, Familial Capillary Malformation-Arteriovenous Malformation syndrome, and Wyburn-Mason syndrome. Visualization of AVMs can be achieve through Computed tomography with arteriography, Magnetic resonance imaging with contrast, or even doppler ultrasound. The gold standard of imaging is catheter angiography, though it is reserved for specific cases due to its invasiveness. Most vulvar AVM cases reported are in premenarchal girls with one report in a postmenopausal patient marked by pruritus over the lesion. Overall, proper history taking, physical exam and noting of concerning features are necessary to determine the need for imaging or ultrasound.