Vulval Haematoma: Symptoms, Treatment and UK Online Doctor Guide

A vulval haematoma is essentially a localized collection of blood outside the blood vessels, occurring within the tissues of the vulva (the external female genitalia). It most commonly affects the labia majora. When the small blood vessels in this area are damaged due to trauma, blood leaks into the surrounding soft tissue, causing significant swelling, pressure, and pain.

Because the tissue in the vulval region is highly vascular (rich in blood vessels) and relatively loose, a haematoma can sometimes form quite rapidly, leading to a visible lump that may feel firm or tense to the touch. While often associated with childbirth, these injuries can happen to women of any age due to various physical accidents.

According to clinical observations in the UK, vulval haematomas are typically caused by blunt force trauma. Common scenarios include:

• Straddle Injuries: Falling onto a hard object like a bicycle crossbar, a fence, or the edge of a bathtub.
• Obstetric Trauma: Tearing or pressure during vaginal delivery, or sometimes following an episiotomy (a surgical cut to assist childbirth).
• Sports Injuries: Accidents during gymnastics, horse riding, or contact sports.
• Sexual Trauma: Though less common, vigorous sexual activity can occasionally lead to tissue damage and subsequent bleeding under the skin.

Regardless of the cause, the mechanism is the same: a rupture of the internal pudendal artery or its branches, leading to a trapped pocket of blood.

Symptoms of a vulval haematoma usually appear immediately or shortly after the injury. You may notice:

• Sudden Swelling: A lump on one side of the vulva that may grow in size over a few hours.
• Discolouration: The skin may appear dark blue, purple, or black, similar to a severe bruise.
• Pain and Tenderness: The area is often extremely sensitive to touch, and walking or sitting may be uncomfortable.
• Pressure: A feeling of fullness or heaviness in the pelvic region.
• Difficulty Urinating: If the swelling is large enough to press against the urethra, it may make passing urine difficult or painful.

If the haematoma is small (typically less than 4-5cm) and not growing, it can often be managed with conservative measures, in line with general UK healthcare advice:

Pain Relief

Over-the-counter analgesics such as paracetamol are usually the first line of defence. Ibuprofen can also help reduce inflammation, provided there are no contraindications like asthma or stomach issues.

Cold Compresses

Applying an ice pack wrapped in a clean towel to the area for 10-15 minutes every few hours can help restrict blood flow and reduce swelling. It is crucial never to apply ice directly to the delicate vulval skin.

Rest

Avoiding strenuous activity and using a 'doughnut' cushion when sitting can take pressure off the affected tissues, allowing the body to reabsorb the collected blood over several days or weeks.

If you have experienced an injury to the vulval area, you may feel hesitant to seek help, but professional advice is important for ensuring proper healing. You should consider booking a consultation to speak to a GP online if:

• The swelling is persistent and does not show signs of improving after 24-48 hours.
• You are unsure if the injury requires stitches or surgical drainage.
• The pain is not controlled by standard over-the-counter medication.
• You need advice on how to manage the injury alongside other health conditions.
• You require a sick note for work due to mobility issues caused by the pain.

An online doctor can review your symptoms, provide clinical advice on wound care, and advise whether an in-person physical examination or referral to a gynaecology unit is necessary. This is a discreet and convenient way to access women's health support from the comfort of home.

For larger or expanding haematomas, the NHS pathway typically involves a referral to a gynaecologist. If the haematoma is larger than 5cm or if the patient's vital signs (like blood pressure) are affected, medical intervention is required.

Incision and Drainage: This is a minor surgical procedure where a small cut is made to remove the clotted blood and secure any bleeding vessels. This immediately relieves the pressure and pain.

Catheterisation: If the swelling prevents urination, a temporary catheter may be inserted to drain the bladder until the inflammation subsides. Antibiotics may also be prescribed if there is a risk of the haematoma becoming infected (an abscess).