Leiomyomas are benign, well-circumscribed, monoclonal smooth muscle tumors. While leiomyoma of the uterus are exceedingly common, soft tissue leiomyomas are rare and often misdiagnosed. While excisional therapy is the mainstay of treatment, wide vulvar excisions can cause significant discomfort and disfigurement of the vulva. Here we present a unique case of a vulvar hematoma excision complicated by hematoma formation. A 39-year-old female presented to the ambulatory gynecology clinic with a 4-month history of an enlarging vulvar mass. On exam, a 4-cm mass was seen arising from the right upper labium. Office biopsy showed a well-circumscribed spindle cell lesion without nuclear atypia that stained diffusely positive for SMA, supportive of leiomyoma. The patient returned 6 months after her initial presentation and reported enlargement of the mass. She also reported that the mass had become painful and interfered with urination. Options of expectant versus surgical management of the vulvar mass were discussed and the patient elected for surgical excision. The patient was taken to the operating room where the vulvar mass was excised. Approximately 4 hours postoperatively, the patient reported worsening vulvar pain and swelling. On bedside exam, the right vulva was enlarged, tense and tender and there was concern for expanding vulvar hematoma. Patient was advised that the return to the operation room for re-exploration and evacuation of presumed hematoma. A significant amount of clot was noted and subsequently evacuated. A venous plexus with multiple feeder vessels was noted to be the culprit of the bleeding and was cauterized to achieve hemostasis. The patient was kept overnight for observation with no further hematoma formation and was discharged home on POD1. Vulvar leiomyomas are exceedingly rare tumors with only 160 documented cases in the literature. Due to the low incidence of these tumors, no standardized diagnostic or treatment algorithms. While surgical excision remains the mainstay of treatment, the approaches used are often varied and provider dependent. This case is unique as it was complicated by postoperative hematoma formation. The vulvar tissue is highly vascularized and capable of tissue expansion contributing to large hematoma formation. Reports such as this can help determine a standardized surgical approach for vulvar leiomyomas to help prevent similar operative complications. Additionally, this study helps elucidate the need for nonoperative approaches to vulvar fibroids in patients who are not surgical candidates.