Leech Infestation in the Vulvar Region: A Possibility to be Considered

DEAR EDITOR, We visited a 75‐year‐old G7L7 rural woman with a painful vulvar lesion highly suspicious for malignancy near the introitus measuring 5 cm × 3 cm × 2 cm. The lesion was oval shaped, erythematous, and purple colored with a soft consistency and started bleeding during examination. Inguinal lymphadenopathy was absent. The patient’s past medical history was unremarkable. Biopsy was planned according to the suspicious clinical appearance of the lesion. Accidently, an experienced gynecologist visited the patient prior to biopsy taking. She became suspicious of the presence of a leech tightly attached to the mucosa of the region and flushed normal saline onto the surface of the lesion. A leech bloated with blood gradually detached from the vulvar mucosa and the suspicious clinical picture almost disappeared. After removal of the leech, we took further history from the patient and understood she does not have access to hygienic water in her village for body cleaning and uses well water for washing the perineal region after voiding. On the review of the literature, we found some reports of leech infestation in the lower female genital tract. Jana et al. have reported 3 cases of the leech bite among 52 rural Indian women with nonobstetric lower genital tract injuries. Aribarg and Phupong from Thailand have reported leech Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, 1Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Correspondence to: Dr. Azar Danesh Shahraki, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: [email protected] Date of Submission: Jun 17, 2013