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CASE REPORT
Year : 2018  |  Volume : 21  |  Issue : 1  |  Page : 52-54

Haematoma of the labia minora following consensual sexual intercourse


Department of Obstetrics and Gynaecology, College of Medicine, Kaduna State University, Kaduna, Nigeria

Date of Web Publication21-May-2018

Correspondence Address:
Dr. Matthew Chum Taingson
Department of Obstetrics and Gynaecology, Faculty of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna
Nigeria
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DOI: 10.4103/smj.smj_33_16

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  Abstract 


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 Sep 24];21:52-4. Available from: http://www.smjonline.org/text.asp?2018/21/1/52/232778




  Introduction Top


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,[1],[2] sexual assault, foreign body insertion, and coitus.[3],[4],[5] Although most are small and pose little threat to the patient, nonobstetric hematomas may become large enough to cause hemodynamic instability.[1] 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 Top


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.
Figure 2: Resolving hematoma involving the right labia minora

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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 Top


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.[6] 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.[7]

Vulva hematoma following consensual sexual intercourse although rare have been documented.[4],[8]

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.[9] Other factors include rough and violent thrusting of the penis during intercourse (consensual and nonconsensual). This traumatic sex may result from hastily performed coitus.[10],[11]

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.[12] 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.[13] 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 Top


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.

Acknowledgment

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Virgili A, Bianchi A, Mollica G, Corazza M. Serious hematoma of the vulva from a bicycle accident. A case report. J Reprod Med 2000;45:662-4.  Back to cited text no. 1
[PUBMED]    
2.
Kunishima K, Takao H, Kato N, Inoh S, Ohtomo K. Transarterial embolization of a nonpuerperal traumatic vulvar hematoma. Radiat Med 2008;26:168-70.  Back to cited text no. 2
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3.
Habek D, Kulas T. Nonobstetrics vulvovaginal injuries: Mechanism and outcome. Arch Gynecol Obstet 2007;275:93-7.  Back to cited text no. 3
[PUBMED]    
4.
Bechtel K, Santucci K, Walsh S. Hematoma of the labia majora in an adolescent girl. Pediatr Emerg Care 2007;23:407-8.  Back to cited text no. 4
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5.
Dash S, Verghese J, Nizami DJ, Awasthi RT, Jaishi S, Sunil M, et al. Severe haematoma of the vulva – A report of two cases and a clinical review. Kathmandu Univ Med J (KUMJ) 2006;4:228-31.  Back to cited text no. 5
    
6.
Palacios Jaraquemada JM, García Mónaco R, Barbosa NE, Ferle L, Iriarte H, Conesa HA, et al. Lower uterine blood supply: Extrauterine anastomotic system and its application in surgical devascularization techniques. Acta Obstet Gynecol Scand 2007;86:228-34.  Back to cited text no. 6
    
7.
Nelson EL, Parker AN, Dudley DJ. Spontaneous vulvar hematoma during pregnancy: A case report. J Reprod Med 2012;57:74-6.  Back to cited text no. 7
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8.
Ngatia JW. Traumatic sex with vulval haematoma formation: Case report and review of literature. East Cent Afr Med J 2015;2:104-5.  Back to cited text no. 8
    
9.
Sloin MM, Karimian M, Ilbeigi P. Nonobstetric lacerations of the vagina. J Am Osteopath Assoc 2006;106:271-3.  Back to cited text no. 9
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10.
Ian SC, Alan O. Non obstetric vaginal trauma. Open J Obstet Gynecol 2013;(3):21-3. Available from: http://www.script.org/journal/ojog.[Last accessed on 2016 Mar 16].  Back to cited text no. 10
    
11.
Singhal VP, Bhargava S, Saxena N. Srivastava A. Case Report – Traumatic vulval injury: A rare case. Int J Gynaecol Plast Surg 2014;4:30-2.  Back to cited text no. 11
    
12.
Propst AM, Thorp JM Jr. Traumatic vulvar hematomas: Conservative versus surgical management. South Med J 1998;91:144-6.  Back to cited text no. 12
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13.
Benrubi G, Neuman C, Nuss RC, Thompson RJ. Vulvar and vaginal hematomas: A retrospective study of conservative versus operative management. South Med J 1987;80:991-4.  Back to cited text no. 13
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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