Non-Obstetric Traumatic Vulvar Hematomas in Premenarchal and Postmenarchal Girls

Published:March 28, 2022DOI:



      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.


      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.


      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.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Papoutsis D
        • Haefner HK
        Large vulvar haematoma of traumatic origin.
        J Clin Diagn Res. 2017; 11: QJ01-QJ02
        • Sau AK
        • Dhar KK
        • Dhall GI
        Nonobstetric lower genital tract trauma.
        Aust N Z J Obstet Gynaecol. 1993; 33: 433-435
        • Jones IS
        • O'Connor A
        Non-obstetric vulval trauma.
        Emerg Med Australas. 2013; 25: 36-39
        • Propst AM
        • Thorp Jr, JM
        Traumatic vulvar hematomas: conservative versus surgical management.
        South Med J. 1998; 91: 144-146
        • Sherer DM
        • Stimphil R
        • Hellmann M
        • et al.
        Transperineal sonography of a large vulvar hematoma following blunt perineal trauma.
        J Clin Ultrasound. 2006; 34: 309-312
        • Dietrich JE
        • Perlman S
        • Hertweck SP
        Post-traumatic vulvar hematoma secondary to coagulopathy caused by rickettsial infection.
        J Pediatr Adolesc Gynecol. 2005; 18: 175-177
        • Ernest A
        • Knapp G
        Severe traumatic vulva hematoma in teenage girl.
        Clin Case Rep. 2015; 3: 975-978
        • Bechtel K
        • Santucci K
        • Walsh S
        Hematoma of the labia majora in an adolescent girl.
        Pediatr Emerg Care. 2007; 23: 407-408
        • Lapresa Alcalde MV
        • Hernández Hernández E
        • Bustillo Alfonso S
        • et al.
        Non-obstetric traumatic vulvar hematoma: conservative or surgical approach? A case report.
        Case Rep Womens Health. 2019; 22: e00109
        • Egan E
        • Dundee P
        • Lawrentschuk N
        Vulvar hematoma secondary to spontaneous rupture of the internal iliac artery: clinical review.
        Am J Obstet Gynecol. 2009; 200: e17-e18
        • Hernández-Tiria MC
        • Navarro-Devia AJ
        • Osorio-Ruiz AM
        Lesión vulvar y perineal secundaria a trauma pelviperineal complejo: presentación de un caso y revisión de la literatura.
        Rev Colomb Obstet Ginecol. 2015; 66: 297-305
        • Hu J
        • Haefner HK
        The management of vacuum-assisted closure following vulvectomy with skin grafting.
        Plast Reconstr Surg Glob Open. 2018; 6: e1726
        • Perkins JD
        • Morris PF
        Traumatic vulvar hematoma masquerading as a Bartholin duct cyst in a postmenopausal woman.
        J Miss State Med Assoc. 2013; 54: 8-10
        • Shesser R
        • Schulman D
        • Smith J
        A nonpuerperal traumatic vulvar hematoma.
        J Emerg Med. 1986; 4: 397-399