title: Vulvar hematoma after cunnilingus in a teenager with essential thrombocythemia: a case report.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Golda Campus, Petah Tiqval, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Rabinerson
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Fradin
authors.forename: Aliza
authors.initials: A
authors.lastname: Zeidman
authors.forename: Eran
authors.initials: E
authors.lastname: Horowitz
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004487:Edema / Q000209:etiology; D005260:Female; D006406:Hematoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D010146:Pain / Q000209:etiology; D012725:Sexual Behavior; D013921:Thrombocytopenia; D014845:Vulvar Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology