What is that???

A 32 y/o G2P2L2 white female, 4 weeks postpartum s/p uncomplicated SVD with epidural presented to the acute care clinic with chief complaint of “blood clot inside labia”. States she noticed a dark red lesion inside her labia that morning. Denied pain, but c/o itching. Denied drainage from lesion, dysuria, hematuria, urinary difficulties, or vaginal discharge. Denied shaving, intercourse, or other trauma. Currently breastfeeding. On inspection and palpation, there was a 1cm x 1cm round, swollen, red, inflamed protrusion in the between the labia minora, covering the urethra and extending to the inferior border of the clitoris. The mass was firm, immobile, and nontender with palpation.


This image above is similar to what I saw.

I wasn’t exactly sure what the lesion was, but the provider immediately recognized it and diagnosed her with urethral prolapse. Urethral prolapse is not a common condition and is often misdiagnosed. Most cases occur in pre-menarchal and post-menopausal women and is thought to be caused as a result of trauma or lack of estrogen causing laxity of the pelvic floor. Our patient probably had multiple factors that contributed to her development of urethral prolapse. Trauma s/p foley catheterization and vaginal delivery and lack of estrogen induced by breastfeeding in the post partal period probably all played a part. Because the condition is uncommon, there is not a clear consensus about treatment, but options include manually replacing the prolapse, estrogen creams, kegels, physical therapy, and surgery. As our patient had a mild prolapse without signs of urinary obstruction, we opted for less aggressive treatment and prescribed estrogen cream and recommended kegels. So if you happen to see a post partum patient with an odd vulvar lesion, keep urethral prolapse in your differentials.