Vulval Haematoma: Causes, Symptoms, and Treatment in the UK

A vulval haematoma occurs when small blood vessels (capillaries or veins) in the vulval region burst, causing blood to leak into the surrounding soft tissue. Because the tissue in this area is highly vascular and relatively loose, blood can collect quickly, leading to a visible lump or significant swelling. In the UK, these are frequently seen following obstetric trauma, but they can also occur in non-pregnant women due to accidents or physical activity.

Unlike a bruise, which is a superficial injury, a haematoma involves a more significant collection of blood that can feel firm or tense to the touch. The severity can range from a small, self-limiting spot to a large, painful mass that interferes with walking or urination.

According to NHS clinical pathways, the most common causes of vulval haematomas include:

• Childbirth: During vaginal delivery, the pressure of the baby’s head or the use of forceps and ventouse can cause internal tearing or vessel rupture. Even if the skin remains intact, a haematoma can form underneath.
• Straddle Injuries: Falling onto a hard object that passes between the legs, such as a bicycle crossbar, a fence, or playground equipment.
• Sexual Trauma: Vigorous sexual activity can occasionally lead to blunt force trauma sufficient to cause a haematoma.
• Post-Surgical Complications: Following procedures such as a labiaplasty or the drainage of a Bartholin’s cyst.
• Pelvic Fractures: In cases of severe trauma, such as a road traffic accident, a haematoma may form alongside other pelvic injuries.

Physical Signs

The primary symptom is a sudden onset of pain followed by swelling. The affected area usually appears dark purple, blue, or black. The skin may feel stretched or shiny. If the haematoma is large, it may cause the labia to appear asymmetrical.

Functional Difficulties

Patients often report difficulty sitting comfortably or walking. In some cases, the swelling is so significant that it presses against the urethra, making it difficult or painful to pass urine (dysuria). If you are unable to urinate at all, this is considered a medical emergency.

For small, stable haematomas that are not increasing in size, conservative management is often recommended. This aligns with NICE clinical knowledge summaries for soft tissue trauma:

• Rest: Avoid strenuous activity and heavy lifting to prevent further bleeding.
• Ice Packs: Apply a cold compress or ice pack wrapped in a clean cloth to the area for 10–15 minutes every few hours during the first 24–48 hours. This helps to constrict blood vessels and reduce swelling.
• Pain Relief: Over-the-counter paracetamol or ibuprofen can be effective. Always follow the dosage instructions on the packet.
• Sitz Baths: After the first 24 hours, warm (not hot) shallow baths can help soothe the area and maintain hygiene.
• Compression: Wearing firm-fitting underwear can sometimes provide gentle pressure to limit further swelling.

If you discover a new lump or significant bruising in the pelvic area, it is natural to feel concerned. While many haematomas are minor, a consultation can provide peace of mind. You should speak to a GP online if:

• The pain is not controlled by over-the-counter medication.
• The swelling is staying the same size or getting slightly larger over 24 hours.
• You are unsure if the lump is a haematoma, a cyst, or an abscess.
• You have signs of a secondary infection, such as increased redness, warmth, or a fever.

An online doctor can review your symptoms, provide a management plan, and if necessary, issue a sick note if your injury prevents you from working. They can also advise if you require an in-person physical examination or a referral to a gynaecology specialist.

If a haematoma is large (typically over 4–5cm) or expanding rapidly, hospital treatment is required. A clinician may need to perform an incision and drainage under local or general anaesthesia. This involves making a small cut to remove the clotted blood and ligating (tying off) the bleeding vessel. In some cases, a small drain may be left in the tissue for 24 hours to prevent the blood from recollecting. Antibiotics may be prescribed if there is a high risk of infection, particularly if the skin was broken during the initial injury.