A vulvar hematoma is a collection of blood within the soft tissues of the external female genitalia, often presenting as a tender, swollen lump. This condition occurs when blood vessels are damaged, allowing blood to pool in the surrounding tissue. Hematomas most commonly result from trauma sustained during childbirth, particularly following an episiotomy, laceration repair, or instrumental delivery. Non-obstetric causes include blunt trauma to the perineum, such as straddle injuries, falls, or vigorous sexual activity.
Understanding Hematoma Severity
The time it takes for a vulvar hematoma to resolve is directly related to its size and whether it continues to expand. Small, superficial hematomas are typically less than 3 to 5 centimeters in diameter and are confined to the immediate area of injury. These smaller collections of blood usually stabilize quickly and do not pose a threat to surrounding tissues.
A large or deep hematoma is generally defined as one greater than 5 to 10 centimeters, or any hematoma that is actively expanding. Hematomas of this size can cause intense pain and may compress nearby structures, such as the urethra, leading to difficulty urinating. The location of the bleeding, particularly if it involves an arterial source, also contributes significantly to the severity and potential for rapid expansion.
Standard Healing Timelines and Prognosis
For a small, stable vulvar hematoma, the initial acute phase of pain and swelling typically begins to subside within the first 48 hours. The majority of the pain and noticeable swelling usually resolves within one to three weeks with conservative management. Complete reabsorption of the blood clot and the return of the tissue to its original state can take four to eight weeks. However, some discoloration or a palpable lump may persist for several months, especially with larger collections.
Healing timelines are highly variable, depending on the individual’s overall health and the volume of blood collected. In cases where surgical drainage is required, the initial relief from pressure is immediate, and recovery often allows patients to mobilize within a few days. The prognosis for vulvar hematomas is generally favorable, with most people experiencing a full recovery regardless of the initial size. The stages of healing involve the breakdown of the clotted blood, which causes the visible bruising to change color from deep purple to green and yellow before fading completely.
Treatment Approaches for Vulvar Hematomas
Management for a vulvar hematoma is based on its size and whether it is stable or expanding. Small, non-expanding hematomas are typically managed conservatively with close observation. This care involves rest, applying ice packs to the area for the first 24 to 48 hours to help limit bleeding, and taking oral pain medication.
For a large or rapidly expanding hematoma, surgical intervention is necessary to prevent complications and relieve severe pressure. The procedure involves making an incision to drain the accumulated blood and clots, followed by identifying and ligating the specific bleeding vessels to stop the hemorrhage. If the bleeding source is difficult to locate or persists, selective arterial embolization may be performed by an interventional radiologist to block the vessel supplying the area.
Recognizing Complications and Warning Signs
Patients must monitor for signs that the hematoma is not healing correctly or is worsening, requiring immediate medical attention. A sudden, sustained increase in pain disproportionate to the size of the hematoma, or a rapid, continuous expansion of the swelling after the first day, are serious warning signs. These changes signal active or recurrent bleeding that requires urgent surgical management.
Signs of infection, such as fever, chills, an increase in local warmth and redness, or the presence of a foul-smelling discharge, should also be reported immediately. A hematoma that grows large enough to mechanically obstruct the urinary tract can cause an inability to pass urine, which requires prompt intervention. Lightheadedness, a rapid heart rate, or a drop in blood pressure can indicate significant blood loss and a need for emergency care to address hemodynamic instability.