Vaginal Hematoma

A vaginal hematoma is when blood collects in the tissues of your vagina and vulva (outer part of your vagina). A hematoma is a collection of blood under your skin that results from a broken blood vessel. They typically happen due to injury.

Hematomas are different from bruises. A hematoma is a more serious bruise because it typically involves damage to larger blood vessels. A hematoma is more likely to swell and turn a deeper shade of red, blue or purple. They’re typically more painful, too.

A vaginal hematoma isn’t usually a serious problem. It happens most often due to childbirth, but it can also happen any time an injury damages your vulva. Most hematomas are temporary and go away on their own. Still, let your healthcare provider know if you have a hematoma on your vaginal area. A hematoma that’s large or growing quickly may need medical attention.

Vaginal hematomas are rare. Between 1 in 300 to 1 in 1,000 of all deliveries result in a vaginal hematoma.

What are the symptoms of a vaginal hematoma?

A hematoma can cause different symptoms depending on where it is and how big it is. Some of the symptoms of a hematoma are:

• Swelling. The affected tissue will swell up or become puffy.
• Skin discoloration. Depending on your skin color, the hematoma may appear shades of red, purple or blue. Over time, the discoloration will fade to yellow.
• Pain. The pressure from the pooled blood may give you pain that ranges from mild to severe. It usually depends on how large the blood vessel was or how bad the original injury is.

What causes a hematoma on your vagina?

All hematomas form due to an injured blood vessel. Injuries can occur to the blood vessels in your genital region just like they can occur in your legs or arms. The injury breaks down the walls of the blood vessel, causing blood to spill into the surrounding tissues.

Some of the most common causes of a vaginal hematoma are:

• Vaginal childbirth due to factors like pushing (especially a long second stage of labor), stretching the birth canal, vaginal tears or from use of medical tools like forceps
• Trauma from a fall or car accident
• Sports like horseback riding, cycling, gymnastics or other activities that involve straddling an object
• Intense sexual intercourse

What are the risk factors for vaginal hematomas?

Anyone with a vagina can get a vaginal hematoma. Risk factors for vaginal hematomas are any type of activity that could possibly injure or damage your vagina.

Childbirth is the biggest risk factor, especially if your baby has macrosomia or your obstetrician needs to use an instrument like forceps to deliver your baby. Having an episiotomy can also increase your risk.

Other risk factors unrelated to childbirth include vulvar surgery or sexual assault (intercourse without consent).

What are the complications of vaginal hematomas?

Most vaginal hematomas don’t cause long-term problems. But, depending on the size and location of the hematoma, there can be complications. Some of the possible complications are:

• Pain. Your pain can last several days or weeks, depending on how long it takes for the hematoma to heal. It could affect your ability to move or do things you enjoy.
• Blood loss. Large hematomas can lead to more blood loss, which could affect things like your heart rate and blood pressure.
• Infection. Sitting or pooling blood has the potential to become a bacterial infection.
• Necrosis. This is when the tissue in the affected area dies due to either not having blood supply or from damage/injury.
• Urinary problems. A hematoma that blocks or obstructs your urethra can make it hard to pee.

How is a vaginal hematoma diagnosed?

A healthcare provider can usually diagnose a vaginal hematoma by looking at it. They may order an ultrasound, CT scan or MRI to see the size of the hematoma or if it’s getting larger. If you haven’t recently given birth, your provider may ask you about your health history or potential causes of the hematoma.

How is a vaginal hematoma treated?

Treatment usually depends on the location and size of the hematoma. A small hematoma will heal on its own with at-home treatment within one to three weeks. At-home treatment could include things like:

• Applying a cold compress to the hematoma several times each day
• Taking over-the-counter (OTC) pain relievers like ibuprofen
• Resting or staying off your feet to let the area heal

Your healthcare provider may recommend surgery to drain a hematoma if it’s large, growing or causing intense pain. Surgery to drain a hematoma involves your provider:

• Numbing the area with a local anesthetic
• Making a small cut (incision) into the hematoma to drain the blood through a tube
• Closing the incision with stitches

Most people recover within a few days of surgery and can return to their typical activities. Complete healing of the hematoma, including skin discoloration, can take a few weeks.

Since everyone is different, ask your healthcare provider what you can expect from the treatment method they suggest.

When should you drain a vulvar hematoma?

Healthcare providers generally wait until a hematoma is larger than 10 centimeters in diameter before recommending surgery. This isn’t a hard and fast rule, but providers believe if the hematoma isn’t growing and isn’t causing uncomfortable symptoms, surgery may not be necessary. Only your healthcare provider can tell you what’s best for your situation.

Can you prevent a vaginal hematoma?

Some causes of vaginal hematoma are hard to prevent. You can’t anticipate a fall or an accident. But there are some activities that increase your risk of injury to your vaginal area that you can anticipate. Avoiding those activities can lower your risk of a vaginal hematoma. Activities that involve repeat force to your vulva — like riding a horse, for example — can increase your risk of injury to your vagina.

What can I expect if I have a vaginal hematoma?

Most make a complete recovery from a vulvar hematoma. Complications and long-term problems from a hematoma on your vagina or vulva are rare.

When should I see my healthcare provider?

Contact your healthcare provider if you have an injury to your vagina and believe you developed a hematoma. They’ll want to examine you and make sure the injury isn’t serious and won’t result in blood loss or other complications.