A vulvar hematoma is a collection of blood that pools in the loose connective tissue of the external female genitalia, often resulting from trauma or injury. This occurs when blood vessels within the vulva rupture, causing blood to leak into the surrounding tissues and form a painful, swollen mass. The vulva’s rich blood supply makes it particularly vulnerable to hematoma formation. While often alarming, most vulvar hematomas are temporary and resolve fully with appropriate management. They are commonly associated with childbirth, but can also arise from blunt trauma, such as a fall or vigorous sexual activity.
Understanding Vulvar Hematomas and Severity
Vulvar hematomas are classified primarily by their size and whether they are expanding, as these factors directly influence the risk of complications and the duration of recovery. Small, superficial hematomas, generally defined as less than 3 to 5 centimeters in diameter, are typically stable and can be managed conservatively. These minor collections of blood usually remain localized and pose a lower risk for significant blood loss or tissue damage.
Larger hematomas, often exceeding 5 or 10 centimeters, or those that continue to increase in size, represent a more serious injury. These larger masses exert considerable pressure on surrounding tissues, which can lead to severe pain and potential complications like tissue death, or necrosis. The most common cause remains obstetric trauma, specifically from vaginal delivery, which can involve stretching of the birth canal, episiotomy, or the use of instruments like forceps. Non-obstetric causes include accidental injury, high-impact sports, or sexual trauma.
Expected Healing Timeframes
The time it takes for a vulvar hematoma to heal is highly variable and depends on its initial size and the treatment approach taken. For small, stable hematomas managed conservatively, the entire process of resolution typically takes between one to three weeks. The initial, most severe pain often begins to subside significantly within the first few days as the pressure from the pooling blood stabilizes.
Swelling is usually the next symptom to improve, noticeably decreasing within the first week or two. The most extended phase of healing involves the reabsorption of the pooled blood, which causes the skin discoloration. This bruised appearance will gradually change color, fading from a dark purple or blue to green, and then yellow, a process that can take several weeks until the skin returns to its normal tone.
In cases where the hematoma is large or required surgical drainage, the initial recovery is different. While the pressure and acute pain are immediately relieved by the procedure, the body then needs time to heal the surgical incision. Full resolution of the underlying bruise and final tissue healing, even after surgical intervention, can still take four to eight weeks or longer, depending on the extent of the original injury.
Treatment Modalities and Recovery Pathways
The choice of treatment directly influences the recovery pathway, aiming to minimize discomfort and prevent complications. Small hematomas, less than 3 to 5 centimeters, are typically managed conservatively with close observation. This protocol involves rest, applying an ice pack intermittently for the first 24 to 48 hours to reduce swelling, and using pain relief medication. Conservative management allows the body’s natural processes to gradually break down and reabsorb the collected blood over several weeks.
For larger hematomas, those over 5 centimeters, or any that are rapidly expanding, surgical intervention is usually the primary treatment. The procedure involves making an incision to drain the accumulated blood and clots, identifying the source of bleeding, and ligating the damaged vessel to prevent recurrence. Surgical drainage provides rapid relief from the pressure and severe pain, often allowing patients to mobilize within a day or two. However, this pathway requires diligent wound care and has a separate recovery period for the surgical site itself, which must be monitored for signs of infection or dehiscence.
When to Seek Urgent Medical Care
While most vulvar hematomas resolve without severe issues, certain signs indicate a complication that requires immediate medical attention. A rapid or continuous expansion of the hematoma is a serious warning sign, suggesting ongoing internal bleeding that could lead to significant blood loss and hemodynamic instability. Symptoms of instability include feeling lightheaded, weak, dizzy, or experiencing a rapid heart rate and low blood pressure.
Signs of infection also warrant urgent care, which can occur as the hematoma begins to break down. These include a persistent high fever, the presence of purulent or foul-smelling discharge from the area, or dramatically increased redness and warmth around the mass. A hematoma that causes difficulty or the complete inability to urinate indicates that the mass is exerting mechanical pressure on the urethra. This requires prompt intervention to prevent urinary retention and potential kidney issues.