|Year : 2018 | Volume
| Issue : 1 | Page : 52-54
Haematoma of the labia minora following consensual sexual intercourse
Matthew Chum Taingson, Joel A Adze, Stephen B Bature, Amina Mohammed Durosinlorun, Mohammed Caleb, Abubakar Amina
Department of Obstetrics and Gynaecology, College of Medicine, Kaduna State University, Kaduna, Nigeria
|Date of Web Publication||21-May-2018|
Dr. Matthew Chum Taingson
Department of Obstetrics and Gynaecology, Faculty of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna
This is a case report of a 21-year-old woman who presented with a large hematoma of her right labia minora after consensual sexual intercourse that resolved following nonsurgical intervention.
Keywords: Consensual sexual intercourse, genital injury, labia minora hematoma
|How to cite this article:|
Taingson MC, Adze JA, Bature SB, Durosinlorun AM, Caleb M, Amina A. Haematoma of the labia minora following consensual sexual intercourse. Sahel Med J 2018;21:52-4
|How to cite this URL:|
Taingson MC, Adze JA, Bature SB, Durosinlorun AM, Caleb M, Amina A. Haematoma of the labia minora following consensual sexual intercourse. Sahel Med J [serial online] 2018 [cited 2018 Jun 19];21:52-4. Available from: http://www.smjonline.org/text.asp?2018/21/1/52/232778
| Introduction|| |
Vulvar hematomas are usually seen in the obstetric population following birth-related soft-tissue injury and repair of episiotomies. However, traumatic nonobstetric vulva hematomas are rare. They may arise secondary to blunt trauma sustained during a fall from height,, sexual assault, foreign body insertion, and coitus.,, Although most are small and pose little threat to the patient, nonobstetric hematomas may become large enough to cause hemodynamic instability. While conservative management is often the mainstay of treatment, there is a subset of the population that will need surgical evacuation and repair. We present the management of a primipara with vulva hematoma following consensual sexual intercourse. Written signed informed consent was obtained on 20th June 2016 for anonymous publication of this case in Sahel Medical Journal.
| Case Report|| |
A 21-year-old Para 1 +3(not alive), unmarried female presented to the accident and emergency unit of Barau Dikko Teaching Hospital Kaduna State, Nigeria, on November 20, 2015, with Vulva pain, swelling, and vaginal bleeding for 8 h. Before the presentation, she had consensual penile-vaginal intercourse with her partner. She denied any aggression, coercion, or instrumentation with other objects on the part of her partner. She had previously had consensual penile-vaginal intercourse with this same partner without any sequelae. Over the following 3 h, the genital pain became unbearable, and she had great difficulty urinating. The vaginal bleeding commenced 2 h after the sexual intercourse, necessitated use of 1 sanitary pad every 3 h.
She attained menarche at the age of 13 years. Her menstrual cycle was every 4 weeks and lasted 5 days. Her last menstrual period was 3 weeks (October 28, 2015) before the presentation. She had no prior problems with irregular or heavy menses. She had a spontaneous vaginal delivery of a live female that weighed 2.5 kg. The baby later died at 4 months of age. Pregnancy, labor, delivery, and puerperium were normal. She had 3 previous termination of pregnancy with, no postabortal sequelae.
On examination, she was in pain and was walking with a waddling gait. She was afebrile (temp 37°C), respiratory rate was 18 cycles per min; her pulse rate was 90 beats per min, regular and good volume, and blood pressure 110/70 mmHg. Abdominal examination revealed no abnormalities.
There was a tense and tender 9 cm × 6 cm × 4 cm right vulva swelling involving the entire right labium minora, and the clitoris. The urethra and vestibule were obscured. There was bright red blood at the vestibule [Figure 1].
|Figure 1: Haematoma of right labia minora and clitoris, obscuring the vestibule|
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She had an examination under anesthesia (EUA), the vulva swelling was cleaned, it spontaneously erupted, and about 400 ml of clots were discharged. Further EUA revealed no other genital injuries, no bleeding vessels seen, and no further bleeding was noted. Vulva toileting was done. The urinary bladder was catheterized using a Foley catheter. She was placed on tablets amoxicillin/clavulanic acid 625 mg twice daily, tablets metronidazole 400 mg 8 hly daily, and tablets diclofenac 50 mg 12 hly. Sitz bath was done twice daily. Foley catheter was removed on the 2nd day, after which she urinated without difficulty. Her packed cell volume done on the 2nd day post-EUA was 25%, screening for sexually transmissible diseases was negative, and she was transfused a unit of blood. She was discharged on the 5th day, at which time the hematoma had remarkably resolved [Figure 2]. She was counseled on safe sex practices and dual contraception.
The patient was seen in follow-up at 4 weeks and the vulva appeared symmetrical with the swelling completely resolved. The patient had no complaints.
| Discussion|| |
The vulva consists mostly of loose connective tissue and smooth muscle that is richly supplied by branches of the pudendal artery; a significant branch of the internal iliac artery. The venous drainage consists of labial veins, which are tributaries of the internal pudendal vein and venae comitantes. The injury to labial branches of the internal pudendal artery, which is located in the superficial fascia of the anterior and posterior pelvic triangle, can cause significant vulvar hematomas.
Vulva hematoma following consensual sexual intercourse although rare have been documented.,
Suggested predisposing factors that may result in such injuries include virginity, insertion of foreign bodies, self-mutilation, disproportion of male and female genitalia, atrophic vagina in postmenopausal women, congenital abnormalities stenosis and scarring of the vagina because of previous surgery, or pelvic radiation therapy. Other factors include rough and violent thrusting of the penis during intercourse (consensual and nonconsensual). This traumatic sex may result from hastily performed coitus.,
This case is unusual for several reasons. Our patient did not present with a history that would predispose to genital injury during consensual sexual intercourse, as neither she nor her partner was intoxicated. She had a previous delivery with no genital laceration. There was also no reported history of genital penetration with any other object.
The blood loss causing a significant decrease in the patient's hematocrit is also another unusual feature of this patient's presentation. This raises the suspicion of an underlying coagulopathy, especially because a bleeding source, such as that from the inferior labial artery or vein, was not identified at the time of examination under anesthesia. The patient neither has medical history suggestive of a coagulopathy, such as menorrhagia, easy bruising, or significant bleeding after trauma, nor was there a family history suggestive of a coagulopathy. However, the patient's hematoma opened spontaneously, and required no surgical intervention.
There are no consensus statements or best practice guidelines for the necessity or timing of surgical intervention to treat vulva hematomas. Propst and Thorp. observed that in the absence of acute hematoma expansion, nonoperative conservative management can yield good results, as in the patient we managed. However, Benrubi et al. found that conservative management of hematomas was associated with longer hospital stay and associated costs, an increased need for antibiotics and blood transfusion and greater subsequent operative intervention. Our patient was managed conservatively with analgesics, antibiotics, blood transfusion, and sitz bath.
| Conclusion|| |
Nonobstetric vaginal trauma after a consensual sexual intercourse, though very rare, was presented. Our patient had a large hematoma that necessitated an EUA and blood transfusion, was managed conservatively with a favorable outcome.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
The authors would like to express gratitude to Prof Lydia Airede, for her critical reading and comments on the case report.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]