Vulvar Haematoma: Causes, Recovery and When to Seek Help in the UK

A vulvar haematoma occurs when small blood vessels in the vulval tissue burst, causing blood to pool under the skin. Unlike a standard bruise, which involves minor capillary leakage, a haematoma is a more significant collection of blood that results in a distinct lump or swelling. In the United Kingdom, these are relatively common findings in both A&E and primary care settings, often following acute trauma to the pelvic region.

The vulva has a rich supply of blood vessels and the surrounding tissue is relatively loose, which means swelling can occur quite rapidly. While the appearance can be alarming, most vulvar haematomas are non-emergency situations that can be managed with conservative care. However, understanding the underlying cause is essential to ensure no other structures, such as the urethra or vaginal wall, have been damaged.

There are several ways a haematoma can develop in the female genital area. According to clinical presentations seen by UK healthcare providers, the most frequent causes include:

• Straddle Injuries: This occurs when a person falls onto an object that they are straddling, such as a bicycle crossbar, a fence, or even the side of a bathtub.
• Sexual Trauma: Intense or non-consensual sexual activity can cause blunt force trauma to the labia, leading to internal bleeding.
• Obstetric Trauma: During childbirth, the pressure of the baby’s head or the use of forceps/ventouse can rupture vessels. Occasionally, a haematoma may form after an episiotomy or a tear is repaired.
• Post-Surgical Complications: Procedures such as a labiaplasty or other gynaecological surgeries carry a small risk of postoperative bleeding into the tissue.
• Direct Impact: Sports injuries or accidental kicks to the groin area can also be a catalyst.

The symptoms of a vulvar haematoma usually appear immediately after the injury, though they can develop over a few hours. The most common signs reported to GPs include:

• Significant Swelling: Often appearing on one side (unilateral), making the labia look asymmetrical.
• Discolouration: The skin may turn deep purple, blue, or black, characteristic of pooled blood.
• Pain and Tenderness: The area is usually very sensitive to touch, and sitting or walking may be uncomfortable.
• A Palpable Mass: You may feel a firm or fluctuant lump under the skin.
• Pressure: A feeling of fullness in the pelvic region.

Differentiating from other conditions

It is important not to confuse a haematoma with a Bartholin's cyst (which is a blockage of a gland) or a vulval abscess (which is usually hot, red, and accompanied by fever). A haematoma is almost always preceded by a clear history of trauma.

If the haematoma is small (typically less than 4cm-5cm) and not growing, UK health guidelines often suggest conservative management. This is because the body will naturally reabsorb the blood over a period of weeks. Recommended self-care steps include:

• Ice Packs: Applying a cold compress wrapped in a cloth to the area for 10–20 minutes every few hours during the first 24–48 hours can reduce swelling and numb the pain.
• Pain Relief: Over-the-counter paracetamol or ibuprofen can help manage discomfort. Always check the patient information leaflet for suitability.
• Rest: Avoid strenuous exercise or activities that put pressure on the pelvic area for several days.
• Loose Clothing: Wear breathable cotton underwear and avoid tight trousers to prevent further irritation.
• Sitz Baths: After the first 48 hours, shallow warm baths may help soothe the area and aid the reabsorption process.

Many women feel embarrassed discussing injuries to the vulval area, but it is a routine part of women's health. You may wish to speak to a GP online if you are unsure if your symptoms require hospital treatment or if you need an assessment for pain management and a sick note for work.

An online consultation allows you to describe the mechanism of injury and your symptoms in a private, calm environment. The doctor can help determine if the haematoma is stable or if you need to be referred to a local gynaecology unit for an in-person examination. If the skin has been broken, they can also advise on the risk of infection and whether antibiotic treatment or a tetanus booster is necessary.

For larger haematomas or those that are causing severe symptoms, the NHS pathway typically involves a referral to a gynaecologist. If the haematoma is expanding rapidly, it indicates an active bleed that needs to be stopped.

Incision and Drainage

If the pain is unbearable or the mass is obstructing the urethra, a doctor may perform a small incision under local or general anaesthesia to drain the clotted blood. The bleeding vessel is then identified and tied off (ligated). The area is usually washed out, and in some cases, a small drain may be left in place for 24 hours.

Observation

In stable but large cases, you may be admitted to a ward for observation to ensure the haematoma does not increase in size and that you are able to pass urine freely. Catheterisation is occasionally required if the swelling puts pressure on the tube that carries urine out of the body.