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

A vulval haematoma occurs when blood vessels within the soft tissues of the vulva (the external female genitalia) rupture, causing blood to pool and form a painful lump. Because the tissue in this area is highly vascular—meaning it has a rich blood supply—and relatively loose, swelling can occur rapidly and become quite large.

In the UK, these injuries are often seen following direct trauma, such as a 'straddle injury' (falling onto a bike frame or fence). While they can be alarming due to the sensitive nature of the area and the speed of discolouration, most cases are manageable with the right clinical guidance. According to NHS clinical standards, the primary goal of treatment is to control pain, prevent infection, and ensure the haematoma does not interfere with urinary function.

Recognising a vulval haematoma usually involves identifying a combination of physical changes and pain. The symptoms often appear immediately after an injury but can sometimes develop over several hours. Key signs include:

• Significant Swelling: One side of the vulva (usually the labia majora) may appear much larger than the other.
• Discolouration: The skin may turn deep purple, blue, or black, similar to a severe bruise.
• Intense Pain: The area is typically very tender to the touch, and the pressure of the pooling blood can cause a throbbing sensation.
• Difficulty Sitting or Walking: The size and location of the swelling can make normal movement uncomfortable.
• Urinary Changes: In some cases, the swelling may press against the urethra, making it difficult or painful to pass urine.

Most vulval haematomas are the result of blunt force trauma. In the United Kingdom, common scenarios include:

1. Straddle Injuries

This is the most frequent cause outside of childbirth. It occurs when a person falls onto an object that passes between their legs, such as a bicycle crossbar, a gymnastic beam, or a playground climbing frame.

2. Obstetric Trauma

During childbirth, the stretching of the vaginal and vulval tissues can cause blood vessels to burst. This may happen during a natural delivery or as a complication of an episiotomy or an instrumental delivery (using forceps or a ventouse).

3. Direct Impact

Accidental kicks, sports injuries, or falls can also lead to significant bruising and haematoma formation in the pelvic region.

4. Post-Surgical Complications

Less commonly, a haematoma may form following gynaecological surgery, such as a labiaplasty or other vulval procedures, if a blood vessel begins to leak after the operation.

Treatment depends largely on the size of the haematoma and whether it is still growing. NICE guidance suggests a conservative approach for small, stable injuries.

Conservative Management (Home Care)

If the haematoma is small (typically under 4-5cm) and the pain is manageable, the following steps are often recommended:

• Ice Packs: Applying a cold compress wrapped in a cloth for 10-15 minutes every few hours can reduce swelling and numb the pain.
• Pain Relief: Over-the-counter medications such as paracetamol or ibuprofen are effective. Always follow the dosage instructions on the packet.
• Rest: Avoiding strenuous activity and staying off your feet can prevent further irritation to the area.
• Sitz Baths: Once the initial swelling has stabilised, shallow warm baths can help soothe the skin.

Surgical Intervention

If the haematoma is large, expanding rapidly, or causing an inability to urinate, a hospital admission may be required. A doctor may perform a 'surgical evacuation,' which involves a small incision to drain the accumulated blood and tie off any bleeding vessels under local or general anaesthetic.

If you have suffered an injury to the vulval area, you may feel hesitant to seek help due to embarrassment. However, getting a professional opinion is vital to ensure proper healing. You should speak to a GP online if:

• The swelling is not improving after 24-48 hours of home care.
• The pain is severe and not controlled by standard paracetamol.
• You are unsure if the injury requires a physical examination or referral to a specialist.
• You notice signs of infection, such as increased redness, heat, or pus.
• You need a sick note for work due to mobility issues caused by the injury.

An online consultation provides a private, calm environment to discuss your symptoms. A GP can assess the history of the trauma, advise on the best course of action, and guide you on red flags that would necessitate an A&E visit.

While most vulval haematomas heal without long-term issues, complications can arise if the injury is not monitored. The most common complication is a secondary infection of the trapped blood. Keeping the area clean and dry is essential. Additionally, large haematomas can occasionally lead to tissue necrosis (skin death) if the pressure is too great, which is why clinical assessment for larger lumps is mandatory.

During recovery, it is advisable to wear loose-fitting cotton underwear and avoid tampons or sexual intercourse until the area has completely healed and any pain has subsided. If you are a cyclist, ensure your saddle is properly fitted and consider padded shorts to reduce the risk of future straddle-type injuries.