Acute vulvar edema

Specialty: Gynecology and breast.

• Sudden vulvar swelling
• unilateral labia majora edema
• non-painful bilateral vulvar swelling

Why it occurs

• Acute allergic reaction (due to contact with latex, semen, topical medications or insect bites)
• Direct perineal trauma (due to vigorous intercourse, sports such as cycling or physical aggression)
• Obstruction of pelvic lymphatic or venous return (due to pelvic masses or pelvic vein thrombosis)
• Postpartum complication (massive vulvar edema after prolonged vaginal delivery or preeclampsia)
• Rapidly progressive soft tissue infection

Initial workup

Ultrasound of soft tissues of the vulvar area to rule out hidden fluid collections or inguinal/vulvar hernias. Pelvic Doppler ultrasound or pelvic computed tomography (CT) if an obstructive pelvic mass or deep vein thrombosis is suspected. Basic laboratory tests including blood count, CRP, kidney function and clotting times.

Standard management

• Dexchlorpheniramine 2 mg orally every 8 hours or Cetirizine 10 mg daily if an acute allergic/reactive etiology is suspected
• Methylprednisolone 20-40 mg orally daily in a short descending regimen for 5 days if the edema is massive and non-infectious
• Local cold compresses applied intermittently to reduce tissue edema secondary to trauma
• Intravenous antibiotic therapy if underlying perineal cellulitis is detected (note: massive postpartum vulvar edema usually resolves spontaneously with rest, elevation of the pelvis and local cold).