What is Vulvar hematoma?
When blood collects outside the blood vessels, it is called hematoma. Such Hematoma occurring, in and around the vulva (internal and external reproductive organs of a female) is known as vulvar hematoma. Vulva includes the small sensitive organ at the mouth of the vagina which expands due to sexual excitement.
What causes it?
- Whenever any damage occur in the vulva region due to any cause, it develops into vulvar hematoma. It also happens due to forced delivery of a child through the vagina, with the use of forceps. It may happen spontaneously or because of the wound caused by forceps which is not properly attended to and appropriate remedial measure/s taken.
- The blood that is collected outside the blood vessels in the region, closes themselves up without any opening to drain resulting in swelling and consequent pain. Episiotomy, forcible opening of the fetus, conducted to make the pathway wider to facilitate delivery of the baby can cause the wound and eventually leading to vulvar hematoma.
- Another incidence of vulvar hematoma is obstetrics. Obstetrics is conducted during pregnancy, parturition or puerperium. Parturition is the process of giving birth and puerperium covers the entire period from delivery to total evolution of the uterus to pre-pregnancy state.
- Trauma of any type, including sexual abuse or straddle injury where the outer clitoral vessels of either side of the vagina crushes into the pubic bone, can cause vulvar hematoma. While the problem is not age specific, it generally occurs to young adults particularly within a day after delivery of the baby.
- Rich vascular supplies to the uterus, vagina and vulva during the process of child birth, has the potential to cause the hematoma. While bleeding due to laceration and incision may be the reasons for hematoma, overweight of the unborn can also cause the damage.
Clinical examination and diagnosis alone can evaluate the extent of seriousness of vulvar hematoma, even though it may be palpable. Generally the nursing doctor or other nursing staff may notice the same and the person affected may feel it only afterwards, that too after experiencing pain.
Even though the occurrence of vulvar hematoma is not very common, it is to be borne in mind that its occurrence has the potential to cause morbidity of serious nature and also post-delivery maternal death.
- Perennial pain developing into unbearable pain of the vulva region
- Bulging of either side of the vagina
- Visible blood clots in the area of incision
- Sometimes bleeding is concealed
- Non-specific symptoms may also be noticed
- Postpartum pain and bleeding need to be differentiated from hematoma of the vulva
Observation and treatment
Once diagnosed as vulvar hematoma, it needs to be clinically managed with close observation. Where the hematoma is large, say about a few centimeters in length and with a bulge and continues to grow in size, immediate surgical intervention may be required In order to arrest the escalating pain. Watching the size for its growth is very important to address the issue. More than the remedy, the patient can be calmed if there is no enlargement of the size.
In most of the patients there may not be any opening of the hematoma which may subside within a day or two. Only in exceptional cases there is a need for clinical or surgical intervention.
It is important to stop the bleeding outside the blood vessels to provide immediate psychological relief to the mother as otherwise she may get scarred of the growing hematoma.
As a first aid, ice bag is placed on the swelling so as to reduce swelling and pain. Certain oral medicines are also administered to mitigate the problem. Incision is properly stitched ensuring no further oozing of blood occurs from the point. A proper drain is put to drain out the blood and remove the clots simultaneously.
If in spite of these efforts there is further continuous bleeding, blood transfusion is also undertaken in very rare circumstances. Generally bed rest is advised for a week in such cases.
Medical conditions of the genital area must be appropriately diagnosed by a doctor and treated as per medical advice only. Self-medication should not be attempted in any case. This article provides an over-view of the problem and is not intended to be used as a guide for treatment or diagnosis.