Vulvar hematoma after cunnilingus in a teenager with essential thrombocythemia: A case report

BACKGROUND: Nonobstetric injuries of the female genital tract constitute up to 0.8% of all gynecologic admissions. Approximately 40% of such admissions are due to coital injuries. Vulvar injuries following cunnilingus have been reported only rarely. CASE: A 17-year-old with known essential thrombocytopenia was being treated with low-dose aspirin and presented with a 4-cm vulvar hematoma that occurred during cunnilingus. The hematoma was evacuated uneventfully, with no signs of further bleeding and no patient complaints. As the patient, a minor under Israeli law, wished to conceal the circumstances from her parents, we told them that she had suffered vulvar trauma from the background disease. CONCLUSION: This case demonstrates an unexpected complication of a necessary treatment for a major disease and the sometimes dual obligation of physicians to their patients and their families.