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

A vulvar haematoma occurs when blood vessels—usually small arteries or veins—rupture in the soft tissues of the vulva, causing blood to collect and form a painful lump or swelling. Unlike a standard surface bruise, a haematoma involves a larger volume of blood trapped deeper within the tissue layers.

In the UK, these are most commonly seen following childbirth (obstetric trauma), but they can also occur due to non-obstetric injuries. The vulva is highly vascular, meaning it has a rich supply of blood vessels, which explains why even relatively minor impacts can result in significant swelling and discomfort. While they can be alarming in appearance, the majority of small vulvar haematomas are not life-threatening and will resolve with appropriate conservative management and rest.

Symptoms of a vulvar haematoma usually appear quite rapidly following an injury. Patients should look out for the following signs:

• Sudden Swelling: A firm or soft lump on one side of the labia (the 'lips' of the vulva).
• Discolouration: The skin may appear dark purple, blue, or black, similar to a severe bruise.
• Intense Pain: The area is often very tender to the touch, and the pressure of the trapped blood can cause a constant aching or throbbing sensation.
• Difficulty Sitting or Walking: Due to the location and size of the swelling, movement can be restricted and uncomfortable.
• Urinary Symptoms: If the swelling is large enough to press against the urethra, it may cause discomfort or a feeling of pressure when trying to pass urine.

While childbirth is the leading cause of vulvar haematomas in the UK, they can occur at any stage of life due to various types of trauma. These are often categorised by healthcare professionals as follows:

Obstetric Trauma

During vaginal delivery, the tissues of the vulva are under immense pressure. A haematoma can form if a blood vessel is damaged during the second stage of labour, even if there is no visible tear (perineal laceration). They are also associated with instrumental deliveries involving forceps or vacuum extraction (ventouse).

Non-Obstetric Trauma

• Straddle Injuries: Falling onto a hard object, such as a bicycle crossbar, a fence, or the side of a bathtub.
• Sexual Trauma: Vigorous or non-consensual sexual activity can occasionally lead to tissue damage and bleeding.
• Direct Impact: Sports injuries or accidental kicks to the groin area.
• Post-Surgical Complications: Bleeding following procedures such as a labiaplasty or the removal of a Bartholin's cyst.

If the haematoma is small (typically less than 4cm-5cm) and not growing, it can often be managed at home using NICE-aligned conservative treatment. The goal is to manage pain and allow the body to reabsorb the blood over several weeks.

• Cold Compresses: Apply a clean ice pack wrapped in a soft cloth to the area for 10-20 minutes every few hours. This helps to constrict blood vessels and reduce further swelling. Do not apply ice directly to the skin.
• Pain Relief: Over-the-counter medications like paracetamol are generally recommended. Ibuprofen may also be used if there are no contraindications, though some clinicians advise caution immediately after an injury to ensure bleeding has fully stopped.
• Rest: Avoid strenuous activity, heavy lifting, or cycling for at least a week to prevent aggravating the injury.
• Pressure: Wearing snug-fitting (but not tight) cotton underwear can provide gentle support to the area.
• Sitz Baths: After the first 24 hours, lukewarm shallow baths can help keep the area clean and provide soothing relief.

If you are unsure about the severity of a vulvar injury, you can speak to a GP online for a clinical assessment. While an online doctor cannot perform a physical examination, they can provide a safe space to discuss your symptoms, review photos (if you are comfortable sharing them via a secure portal), and advise on the next steps.

An online consultation is particularly useful for:

• Confirming if your symptoms align with a simple haematoma or require further investigation.
• Obtaining prescription-strength pain relief if over-the-counter options are insufficient.
• Discussing wound care if the skin over the haematoma has broken.
• Receiving a sick note if your injury prevents you from working during the recovery phase.
• Providing a referral to a local gynaecology clinic if the haematoma is slow to heal.

If the GP suspects the haematoma is expanding rapidly or if you are in extreme distress, they will direct you to the nearest Urgent Care Centre or A&E department for an in-person assessment.

For larger or more complex haematomas, NHS hospital specialists may recommend active intervention. If the haematoma is greater than 5cm or causing significant urinary obstruction, Incision and Drainage (I&D) may be performed. This involves making a small cut under local or general anaesthesia to remove the clotted blood and secure any bleeding vessels (haemostasis). In some cases, a small drain may be left in the tissue for 24 hours to prevent the blood from re-collecting.

Antibiotics are not usually required for a simple haematoma unless there are signs of secondary infection, such as increased redness, heat, or a fever. Most patients recover fully within 2 to 6 weeks depending on the initial size of the injury.