Vulvar Haematoma: Symptoms, Causes, and Recovery in the UK

A vulvar haematoma is a localised collection of blood that forms within the soft tissues of the vulva, the external part of the female genitalia. This occurs when a blood vessel—usually a small artery or vein—is damaged, causing blood to leak into the surrounding subcutaneous tissue. Because the tissue in this area is highly vascular and relatively loose, the swelling can sometimes become quite significant in a short amount of time.

Patients often describe the sensation as a sudden, intense pressure or a 'splitting' pain. Visually, the area will appear swollen, firm to the touch, and discoloured (typically dark purple, blue, or black). While the appearance can be alarming, many small vulvar haematomas are considered minor injuries that the body can reabsorb over several weeks, much like a standard bruise elsewhere on the body.

In the UK, the two most frequent causes of a vulvar haematoma are childbirth and accidental trauma. During a vaginal delivery, the immense pressure on the pelvic floor or the use of instruments like forceps can cause internal vessels to rupture. Sometimes, a haematoma develops following an episiotomy or a tear if a vessel continues to bleed beneath the stitched skin.

Non-obstetric causes are also common and include:

• Straddle injuries: Falling onto a hard object, such as a bicycle crossbar, a fence, or the side of a bathtub.
• Sexual activity: Intense friction or accidental trauma during intercourse can occasionally lead to vessel damage.
• Post-surgical complications: Following gynaecological procedures such as a labiaplasty or Bartholin's cyst removal.
• Saddle injuries: Common among horse riders or cyclists who experience repetitive impact or sudden trauma.

The primary symptom of a vulvar haematoma is acute pain combined with visible swelling on one side of the labia. Unlike a standard infection or cyst, a haematoma usually appears very rapidly following an event. Symptoms include:

• A firm, 'tense' lump that feels filled with liquid or semi-solid mass.
• Deep purple or blue skin discolouration.
• Difficulty sitting, walking, or wearing tight clothing due to pressure.
• Pain when passing urine (stinging) if the swelling is near the urethra.
• In more severe cases, a feeling of pelvic pressure or a desire to strain.

How is it different from a Bartholin's Cyst?

It is important to differentiate between a haematoma and a Bartholin's cyst. A cyst usually develops slowly and is often the colour of normal skin (unless infected), whereas a haematoma is almost always associated with trauma and significant bruising.

Following NICE clinical knowledge summaries and general NHS pathways, the treatment for a vulvar haematoma depends largely on its size and whether it is stable (not growing). If the haematoma is small (typically less than 4-5cm) and you are able to pass urine without difficulty, conservative management is usually recommended.

Home Care Measures

• Ice Packs: Applying a cold compress wrapped in a clean cloth for 10-20 minutes every few hours can reduce swelling and numb the pain.
• Pain Relief: Over-the-counter paracetamol or ibuprofen is usually effective for managing discomfort.
• Rest: Minimising physical activity helps prevent further irritation to the area.
• Hygiene: Keeping the area clean and dry is vital to prevent secondary infections, especially if there is any graze on the skin.

If the haematoma is large, extremely painful, or continuing to expand, a doctor may recommend a minor surgical procedure called 'incision and drainage'. This involves making a small cut to remove the clotted blood and ligating (tying off) the bleeding vessel to prevent recurrence.

If you have experienced an injury or have noticed sudden swelling in the genital area, you might feel hesitant to seek help in person immediately. You can speak to a GP online to get a professional assessment from the comfort of your home. An online GP consultation allows you to describe your symptoms, discuss the cause of the injury, and receive advice on whether the haematoma can be managed at home or if you need a referral to a local gynaecology unit.

An online doctor can also provide sick notes if your injury makes it impossible to work or perform daily tasks. During the consultation, the doctor will ask about your ability to pass urine, the stability of the swelling, and your pain levels to ensure you are following the safest clinical pathway.

Recovery time for a vulvar haematoma varies. A small bruise may fade within 7 to 10 days, while a larger haematoma can take several weeks for the body to fully reabsorb the trapped blood. During this time, the lump may change colour from purple to green and yellow, just like a healing bruise on your arm or leg.

Most women recover fully with no long-term complications. However, it is important to monitor the area for signs of infection, such as increased redness, heat, or the presence of pus. Following the advice of a healthcare professional ensures that the healing process remains on track and that any complications are caught early.