Vaginal lesions are abnormalities, sores, lumps, or changes in skin texture in the vaginal or vulvar area. They vary significantly in appearance and underlying cause. Understanding these potential causes is important for proper identification and management.
Infectious Origins
Infectious agents commonly cause vaginal lesions with distinct physical manifestations. The herpes simplex virus (HSV) causes painful blisters that rupture into sores. These lesions often appear in clusters and can recur periodically.
Syphilis, a bacterial infection, causes a characteristic chancre. This sore is usually painless, firm, and round, forming at the site of bacterial entry. Chancres are often found on or around the vulva and may go unnoticed.
Human papillomavirus (HPV) manifests as genital warts, which are growths or bumps on the skin. These warts vary in appearance, sometimes as single bumps or larger, cauliflower-like clusters. They can be flat or raised, smooth or rough, and may be flesh-colored, white, gray, purple, or brown.
Molluscum contagiosum, a viral skin infection, produces small, firm, pearly bumps. These lesions often have a tiny central indentation and are 2-5 millimeters in diameter. While usually painless, they can sometimes be itchy.
Inflammatory and Dermatological Conditions
Vaginal lesions also arise from non-infectious inflammatory and dermatological skin conditions. Lichen sclerosus is a chronic condition characterized by thin, white, patchy skin, often with intense itching and potential tearing. Affected skin may appear crinkly or thickened, sometimes forming small cracks or blood blisters.
Lichen planus is an inflammatory condition causing reddish-brown patches, purplish flat-topped bumps, or erosions in the vulvar area. It often results in pain, burning, and itching; severe cases may lead to scarring that alters vulvar structure. This condition can involve the vulva and vagina, sometimes appearing as raw red areas with a white, lacy pattern.
Contact dermatitis occurs as an allergic or irritant reaction to substances touching the skin. This can lead to redness, itching, burning, and sometimes small blisters or raw, weeping areas. Common triggers include certain soaps, detergents, douches, lubricants, or specific fabrics.
General skin conditions like psoriasis and eczema can affect the vulvar area. These conditions cause red, inflamed, and sometimes scaly patches. The irritation from these chronic conditions can make delicate vulvar tissue more susceptible to damage.
Physical Irritation and Trauma
Physical forces, including friction and direct injury, can lead to vaginal lesions. Constant friction from tight clothing, prolonged sitting, or vigorous activities can irritate the skin, causing redness, chafing, and even small tears or sores. The delicate vulvar skin is vulnerable to such mechanical stresses.
Sexual activity, especially without adequate lubrication or involving rough movements, can result in abrasions, cuts, or tears to vaginal and vulvar tissues. Vaginal dryness, influenced by arousal levels or hormonal changes like menopause, increases the likelihood of these injuries. Foreign objects, such as tampons or menstrual cups, if inserted or removed improperly, can also cause irritation or direct injury to vaginal walls or external genitalia.
Allergic reactions to external irritants can also cause physical trauma. Products like harsh soaps, feminine hygiene products, or condom materials can trigger a localized inflammatory response. This leads to symptoms such as itching, burning, redness, and swelling, manifesting as lesion-like changes.
Less Common but Serious Causes
While less frequent, some causes of vaginal lesions warrant careful consideration due to their seriousness. Cysts and other benign growths can appear as lumps or swellings in the vulvar region. Bartholin’s cysts form when their ducts become blocked, appearing as round, sometimes painless, bumps near the vaginal opening. Sebaceous cysts, containing an oily material, develop when oil-producing glands become blocked.
Precancerous conditions, such as Vulvar Intraepithelial Neoplasia (VIN), involve abnormal cell changes on the surface layer of the vulva. VIN can present with persistent itching, burning, soreness, or changes in skin appearance, including new growths or discoloration (white, red, pink, gray, brown, or black). These skin changes can also appear warty or thickened.
In rare instances, a new or changing lesion, ulcer, or lump that does not heal could indicate vulvar cancer. Persistent, non-healing sores or ulcers on the vulva are concerning signs. Any unusual or concerning lesion that persists should prompt timely medical evaluation to determine its nature and appropriate course of action.