ABSTRACT
Background
Traumatic non-obstetrical hematomas of the vulva are rare, and most reports only involve
adult patients. There are no data on presentation, management, and outcomes from either
conservative or surgical management in pediatric and adolescent patients. The objective
of this project was to compare the etiology, treatment, and outcomes of traumatic
vulvar hematomas occurring in premenarchal and postmenarchal young women.
Methods
A retrospective chart review was performed on females aged 0-24 years seen at a tertiary
care academic center using ICD 9 and 10 codes for traumatic vulvar hematoma from 2006-2019.
Data describing their clinical presentation and course were collected. IRB approval
was obtained.
Results
Twenty patients, aged 3-23 years (median age of 13.5 years) were identified. All 8
premenarchal patients presented with a straddle injury, whereas only 50% of postmenarchal
patients were found to have a straddle injury. Other etiologies among postmenarchal
patients included consensual sexual intercourse and recent vulvar surgery. Hematoma
diameter ranged from 1-3 cm in premenarchal patients and 0.4-7 cm in postmenarchal
patients. Associated perineal lacerations were reported in 50% of the premenarchal
girls and 8% of postmenarchal young women.
Of the 8 premenarchal patients, 5 were managed conservatively, and 3 were taken to
the operating room for repair of perineal lacerations; 1 patient also underwent evacuation
of a 3-cm hematoma. Of the 12 postmenarchal patients, 5 had surgical intervention,
2 for pain secondary to large 7-cm hematomas and 3 for suspected vulvar abscesses,
which were identified as hematomas after drainage. One patient in each group required
a Foley catheter for comfort.
Two postmenarchal patients required a second surgery for further wound management.
One premenarchal patient with surgical treatment required a follow-up exam under anesthesia.
Four patients were admitted for pain and postoperative observation, 1 of whom was
premenarchal.
Eleven patients were seen for follow-up, and 10 were doing well. One postmenarchal
patient in the conservative management group returned to the Emergency Department
with continued pain 10 days later.
Conclusions
In this study that examined traumatic vulvar hematomas in premenarchal and postmenarchal
young women, the only mechanism of injury in premenarchal girls was straddle injury,
and surgical intervention was usually needed only for repair of perineal lacerations,
not a primary hematoma. In the postmenarchal patients, surgical intervention was undertaken
for larger hematomas and suspected vulvar abscesses. Our study suggests that most
hematomas up to 3 cm in premenarchal patients and up to 6 cm in postmenarchal patients
can be managed conservatively.
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Article info
Publication history
Published online: March 28, 2022
Accepted:
March 18,
2022
Received in revised form:
February 27,
2022
Received:
September 21,
2021
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
