Acute giant post-coital vulvar hematoma

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.