Which of the following can be a symptom of a cystocele?

A cystocele occurs when the wall between a woman's bladder and her vagina weakens, allowing the bladder to bulge into the vaginal wall. This condition is often associated with symptoms such as vaginal pressure or a feeling of bulging. Women might notice this sensation particularly when they are active, coughing, or straining. The presence of vaginal pressure or bulging is a direct result of the anatomical shift caused by the cystocele, making this the correct answer.

In contrast, symptoms like difficulty in swallowing, difficulty in breathing, or chest pain are associated with other medical conditions and would not relate to the specific anatomical and functional changes that occur with a cystocele.