A woman 4 hours postpartum reports sudden, excruciating vulvar pain and severe rectal pressure. What condition is likely?

In the context of a woman who is 4 hours postpartum experiencing sudden, excruciating vulvar pain and severe rectal pressure, a vulvar hematoma is a likely condition.

After delivery, especially in cases where there has been a perineal tear, episiotomy, or extended labor, there is a chance for bleeding to occur under the skin in the vulvar area. A hematoma forms when blood collects outside of blood vessels, leading to swelling, pain, and increased pressure in the area. The intensity of pain and the associated rectal pressure that the woman is experiencing can often indicate that there is a significant accumulation of blood, which is characteristic of a vulvar hematoma.

In addition, the timing—just 4 hours postpartum—suggests that any bleeding would still be fresh and the clotting processes may not fully manage the situation yet, making symptoms more pronounced. This differentiates it from other conditions such as a Bartholin gland cyst or a vulvar abscess, which typically develop more gradually and may not present with such acute severity immediately after childbirth.

Recognizing the signs and symptoms of a vulvar hematoma is essential for prompt diagnosis and management, including potential surgical intervention or drainage if necessary.