Vulvar Lesions: Causes, Symptoms, and Treatment

What is Vulvar Lesions?

A vulvar lesion is an abnormal change in the skin or tissue of the vulva, the external part of the female genitalia. These lesions can appear as bumps, sores, ulcers, or discolored patches. They may be painful, itchy, or cause no symptoms at all. Vulvar lesions can result from infections, skin conditions, or more serious health issues, so it's important to have them evaluated by a healthcare provider.

Source: Mayo Clinic

Common Causes

Vulvar lesions can be caused by a variety of conditions, including:

• Infections:
  • Genital herpes (HSV): A viral infection causing painful blisters or ulcers.
  • Human papillomavirus (HPV): A viral infection that can cause genital warts.
  • Yeast infections (Candidiasis): Fungal infections leading to redness, itching, and sometimes white patches.
  • Bacterial vaginosis or other bacterial infections: Can cause irritation and sores.
• Sexually Transmitted Infections (STIs):
  • Syphilis: Can cause painless ulcers (chancres) in its early stages.
  • Chlamydia or gonorrhea: May lead to inflammation and lesions.
• Skin Conditions:
  • Lichen sclerosus: A chronic skin condition causing thin, white patches that may tear or bleed.
  • Lichen planus: An inflammatory condition leading to itchy, purple or white lesions.
  • Eczema or psoriasis: Can affect the vulvar area, causing red, scaly patches.
• Other Causes:
  • Contact dermatitis: Allergic reactions to soaps, detergents, or other irritants.
  • Vulvar intraepithelial neoplasia (VIN): Precancerous changes in vulvar skin cells.
  • Vulvar cancer: Rare but serious, often appearing as a persistent sore or lump.
  • Trauma or friction: From tight clothing, shaving, or sexual activity.

Sources: CDC, NIH

Associated Symptoms

Vulvar lesions may be accompanied by other symptoms, depending on the underlying cause. Common associated symptoms include:

• Itching or burning sensation
• Pain or discomfort, especially during urination or sexual intercourse
• Redness, swelling, or inflammation
• Unusual vaginal discharge (e.g., thick, white, or foul-smelling)
• Bleeding or spotting not related to menstruation
• Tenderness or sensitivity in the vulvar area
• Enlarged lymph nodes in the groin (in cases of infection or cancer)

If you notice any of these symptoms alongside vulvar lesions, it’s important to seek medical advice for proper diagnosis and treatment.

Source: Cleveland Clinic

When to See a Doctor

You should consult a healthcare provider if you experience any of the following:

• Lesions that do not heal within a week or two
• Lesions that are painful, bleeding, or growing in size
• Severe itching, burning, or discomfort that interferes with daily life
• Unusual vaginal discharge or odor
• Recurrent lesions (coming back after treatment)
• Lesions accompanied by fever, fatigue, or swollen lymph nodes
• Any new or changing mole or skin growth on the vulva

Early evaluation is key to determining the cause and starting appropriate treatment.

Diagnosis

To diagnose the cause of vulvar lesions, your healthcare provider may perform the following:

• Medical history: Discussion of symptoms, sexual history, and any previous infections or skin conditions.
• Physical examination: A visual and manual inspection of the vulva and surrounding areas.
• Pelvic exam: To check for abnormalities in the vagina, cervix, or uterus.
• Laboratory tests:
  • Swabs for bacterial, viral, or fungal cultures
  • Blood tests for STIs (e.g., herpes, syphilis, HIV)
  • HPV testing if genital warts are suspected
• Biopsy: A small tissue sample may be taken for microscopic examination if cancer or precancerous changes are suspected.
• Colposcopy: A magnified examination of the vulva and vagina using a special instrument called a colposcope.

Based on these evaluations, your provider can determine the underlying cause and recommend treatment.

Source: World Health Organization (WHO)

Treatment Options

Treatment for vulvar lesions depends on the underlying cause. Here are some common approaches:

Medical Treatments

• Antiviral medications: For herpes (e.g., acyclovir, valacyclovir).
• Antifungal creams or oral medications: For yeast infections (e.g., fluconazole, clotrimazole).
• Antibiotics: For bacterial infections (e.g., doxycycline for syphilis, azithromycin for chlamydia).
• Topical steroids: For inflammatory skin conditions like lichen sclerosus or lichen planus.
• Cryotherapy or surgical removal: For genital warts or precancerous lesions.
• Immunotherapy or chemotherapy: For vulvar cancer, depending on the stage and type.

Home and Supportive Care

• Keep the area clean and dry to prevent irritation.
• Avoid scented soaps, bubble baths, or douches that can worsen irritation.
• Wear loose, breathable cotton underwear to reduce friction.
• Apply cool compresses or take oatmeal baths to soothe itching.
• Use over-the-counter pain relievers (e.g., ibuprofen) for discomfort, if approved by your provider.
• Avoid sexual activity until lesions are healed, especially if they are caused by an STI.

Always follow your healthcare provider’s recommendations for treatment and follow-up care.

Source: Mayo Clinic

Prevention Tips

While not all vulvar lesions can be prevented, you can reduce your risk by following these tips:

• Practice safe sex: Use condoms to reduce the risk of STIs.
• Maintain good hygiene: Clean the vulvar area gently with mild, unscented soap and water.
• Avoid irritants: Steer clear of harsh soaps, douches, and scented feminine products.
• Wear breathable clothing: Choose cotton underwear and avoid tight-fitting pants.
• Stay dry: Change out of wet swimsuits or sweaty workout clothes promptly.
• Get vaccinated: The HPV vaccine can protect against strains of the virus that cause genital warts and some cancers.
• Regular check-ups: Visit your healthcare provider for routine gynecological exams.
• Manage chronic conditions: If you have a skin condition like eczema or psoriasis, work with your provider to keep it under control.

Prevention is especially important for recurrent conditions like herpes or yeast infections.

Emergency Warning Signs

Seek immediate medical attention if you experience any of the following:

• Lesions that are rapidly growing, bleeding heavily, or causing severe pain.
• Signs of a severe infection, such as high fever, chills, or extreme fatigue.
• Difficulty urinating or severe pain during urination.
• Swollen, tender lymph nodes in the groin that do not improve.
• Lesions that ulcerate (break open) and do not heal within a few weeks.
• Any lesion that changes in color, size, or shape, especially if it becomes irregular or darkened.

These symptoms may indicate a serious infection, advanced STI, or even cancer. Do not delay seeking care.

Source: CDC

Vulvar lesions can be concerning, but many causes are treatable with the right medical care. If you notice any unusual changes in your vulvar area, don’t hesitate to reach out to a healthcare provider for evaluation and guidance.