Acute giant post-coital vulvar hematoma

¹Department of Obstetrics and Gynecology, Faculty of Medicine of Tunis, University of Tunis Elmanar, Ben Arous Hospital, Tunis, Tunisia

^&Corresponding author
Nesrine Souayeh, Department of Obstetrics and Gynecology, Faculty of Medicine of Tunis, University of Tunis Elmanar, Ben Arous Hospital, Tunis, Tunisia

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A 26-year-old gravida 2 para 2 with no medical history, presented for vulvar mass and pain occurring after vaginal intercourse. General examination found a 90 beats/min heart rate and 100/60 mmHg blood pressure. On inspection, we noted the presence of a perineal mass measuring 15 x 10 cm in a long axis, firm to palpation, taking the entire right labia majora and labia minora and extending to the lower two-thirds of the vagina. Cervix and vaginal walls examination showed no lacerations nor active bleeding. Hemoglobin was 11.6 g/dL, and platelet and coagulation parameters were normal. The hematoma was evacuated under locoregional anesthesia by nympho-hymeneal incision and irrigated with saline solution. Hemostatic sutures and electrocoagulation stopped the bleeding. The remaining cavity was partially closed up leaving a passive drain. Post-operative follow-up was uncomplicated, and the patient was discharged two days later under antibiotics and anti-inflammatory treatment. Clinical follow-up showed complete wound healing after two weeks with no residual dyspareunia.

Figure 1: A) pre-operative aspect of vulvar hematoma; B) per operative aspect of vulvar hematoma: evacuation of the hematoma via a nympho-hymeneal incision; C) post-operative aspect of vulvar hematoma: remaining cavity after bleeding control; D) postoperative aspect of vulvar hematoma: final aspect