Treating a vaginal or vulvar sore depends entirely on what’s causing it. The two most common causes in sexually active people are genital herpes and syphilis, but sores can also come from skin irritation, yeast infections, trauma, or chronic skin conditions. Some sores heal on their own, while others need prescription medication to clear up. Getting the right diagnosis is the essential first step, because treatments differ dramatically depending on the cause.
What’s Most Likely Causing the Sore
Sores on or around the vagina generally fall into two categories: infectious and non-infectious. Among infections, herpes simplex virus and syphilis account for the vast majority of genital ulcers in the United States. Less common infectious causes include chancroid and lymphogranuloma venereum. Non-infectious causes include yeast infections, physical trauma from friction or shaving, contact dermatitis from irritating products, and chronic skin conditions like lichen sclerosus or psoriasis.
In their early stages, genital sores can look like small bumps or a rash. Herpes sores typically appear as clusters of small, fluid-filled blisters that break open and become painful ulcers. A syphilis sore (called a chancre) is usually a single, firm, round ulcer that may not hurt at all. Sores from contact dermatitis tend to look more like a red, irritated rash with possible cracking or peeling of the skin.
Getting the Right Diagnosis
You cannot reliably tell what’s causing a genital sore just by looking at it. A healthcare provider will typically swab the base of the sore for a nucleic acid amplification test (NAAT), which can detect herpes, syphilis, and other infections with high accuracy. Blood tests for syphilis may also be drawn. If the sore persists and all test results come back negative, a small tissue biopsy can help rule out chronic skin conditions or, rarely, something more serious like cancer.
This testing matters because the wrong treatment won’t help. An antiviral won’t clear a bacterial infection, and an antibiotic won’t touch a virus. Skipping the diagnosis step is the most common reason genital sores don’t improve.
Treatment for Herpes Sores
Genital herpes is treated with antiviral medication. For a first outbreak, treatment typically lasts 7 to 10 days and can be extended if the sores haven’t fully healed. Antiviral pills don’t cure the virus, but they significantly shorten the outbreak, reduce pain, and lower the chance of spreading the infection. Starting medication early, ideally within the first day or two of symptoms, makes it most effective.
For people who get frequent recurrences (more than a few outbreaks per year), daily suppressive antiviral therapy can reduce the number of outbreaks by about half or more. Each recurrent episode is also typically shorter and less painful than the first one.
Treatment for Syphilis Sores
Primary syphilis is cured with a single injection of penicillin. This is one of the most straightforward treatments in medicine, and it’s been the gold standard for decades. If you’re allergic to penicillin, alternative antibiotics are available, though your provider may recommend desensitization so penicillin can still be used. After treatment, the sore typically heals within a few weeks. Follow-up blood tests confirm the infection has cleared.
Syphilis sores can be painless, which means some people ignore them. Left untreated, syphilis progresses through stages and can eventually cause serious damage to the heart, brain, and other organs. Even if the sore goes away on its own, the infection is still active without treatment.
Treatment for Irritation and Contact Dermatitis
Many vaginal and vulvar sores aren’t caused by infections at all. Contact dermatitis, where the skin reacts to an irritating substance, is a common culprit. Known irritants include soap, bubble bath, scented laundry detergent, synthetic underwear, menstrual pads, panty liners, douches, spermicides, tea tree oil, perfumes, and even certain toilet papers. Nickel (from piercings) and fabric dyes can also trigger reactions.
The primary treatment is identifying and removing the irritant. Switch to fragrance-free, dye-free products. Wear cotton underwear. Stop using douches or scented wipes. In most cases, the skin heals on its own once the offending product is eliminated. For persistent irritation, a provider may prescribe a mild topical steroid to calm the inflammation.
Treatment for Chronic Skin Conditions
Lichen sclerosus is a chronic condition that causes white, patchy skin on the vulva that can crack, blister, and form sores. It’s not an infection or an STI. Treatment involves a prescription-strength steroid ointment applied twice daily for several weeks, then tapered to twice a week for long-term maintenance. This regimen controls symptoms effectively for most people, though the condition tends to recur if treatment stops entirely. Regular follow-up is important because, in rare cases, long-standing lichen sclerosus can increase the risk of skin changes that need closer monitoring.
Home Care for Pain Relief
While waiting for a diagnosis or during treatment, several things can ease discomfort. Sitz baths are one of the most effective options: sit in a shallow basin of warm water (around 104°F or 40°C) for 15 to 20 minutes. You can do this three to four times a day. The warm water soothes irritated tissue and helps keep the area clean without harsh products.
Other practical steps that help:
- Keep the area dry. Pat gently with a soft towel after bathing rather than rubbing.
- Wear loose clothing. Tight pants and synthetic fabrics trap moisture and increase friction.
- Avoid irritants. Don’t apply soap directly to the sore. Rinse with plain water instead.
- Use over-the-counter pain relief. Ibuprofen or acetaminophen can help with pain and inflammation.
- Urinate in the bath. If sores make urination painful, peeing while sitting in warm water dilutes the urine and reduces stinging on contact.
Topical numbing gels containing lidocaine are sometimes used for genital pain, though evidence for their effectiveness on open sores is limited. If you try one, use a water-based product and avoid applying it to broken skin unless directed by a provider.
Signs That Need Prompt Attention
Certain symptoms alongside a genital sore suggest the infection or condition is more serious. Fever, swollen lymph nodes in the groin, foul-smelling vaginal discharge, and pain during urination or sex all warrant a timely medical visit. A sore that doesn’t heal within two to three weeks, keeps growing, or bleeds easily also needs evaluation. Multiple sores appearing at once, or sores that return repeatedly, point toward an infection that benefits from specific treatment rather than watchful waiting.
Some sores that seem minor, particularly painless ones, can signal conditions like syphilis that progress silently if untreated. The absence of pain doesn’t mean the sore is harmless.