Vulvar ulcers are sores or breaks in the skin of the vulva, the external female genitalia. These lesions can cause significant discomfort and anxiety, prompting many to seek information about the underlying cause. While the presence of any genital sore can be alarming, not all vulvar ulcers indicate a serious health concern. This article provides clear information regarding what vulvar ulcers are, their causes, how they present, and their management.
What Exactly Are Vulvar Ulcers
A vulvar ulcer is a break in the skin or mucous membrane of the vulva that results in the loss of surface tissue, exposing the layers underneath. The vulva includes the labia majora, labia minora, and the clitoris, and ulcers can appear on any of these structures. This physical disruption is caused by inflammation leading to tissue death and an open sore.
These sores vary significantly in appearance, providing clues to the underlying cause. Some ulcers begin as small bumps or rashes that eventually open up, while others appear as immediate breaks in the skin. They may be single or multiple, deep or shallow, and can have raised or flat margins.
The color and associated characteristics also differ. Some ulcers may leak fluid, bleed easily, or be covered with a yellowish or gray base. An ulcer may be intensely painful, or it may be completely painless, such as the chancre associated with primary syphilis. Due to this wide variation, visual examination alone is insufficient for diagnosis and necessitates further medical investigation.
Primary Causes of Vulvar Ulcers
The causes of vulvar ulcers are broadly categorized into infectious, inflammatory/autoimmune, and traumatic or irritant sources. Sexually transmitted infections (STIs) are the most frequent cause worldwide and require specific, prompt treatment. Herpes Simplex Virus (HSV), particularly HSV-2, is the leading cause of genital ulcers in the United States, typically presenting as painful, clustered blisters that break open. Syphilis, caused by the bacterium Treponema pallidum, produces a single, firm, and classically painless ulcer called a chancre.
A range of other infections can also lead to vulvar ulceration. These include bacterial infections like chancroid or lymphogranuloma venereum, and fungal infections like vulvovaginal candidiasis. Non-sexually transmitted viral illnesses, such as the Epstein-Barr virus or the virus responsible for chickenpox and shingles, can also sometimes trigger ulcer formation.
Non-infectious causes often involve the body’s immune system or external damage to the skin. Certain autoimmune conditions, such as Crohn’s disease and Behçet’s disease, can cause recurrent, painful ulcers on the vulva, often alongside ulcers in the mouth. In young women, vulval aphthosis, sometimes called Lipschütz ulcers, is a non-sexually acquired ulceration that may follow a systemic illness or be related to an inflammatory process.
External factors, classified as traumatic or irritant causes, are also common sources of ulcers. Constant friction, such as from tight clothing or excessive scratching, can lead to skin breakdown and ulcer formation. Allergic reactions to common products like harsh soaps, fragranced detergents, or topical creams can result in contact dermatitis, which may progress to an ulcer or erosion.
Identifying Symptoms and When to Seek Care
While the ulcer itself is the primary sign, it is often accompanied by other symptoms that indicate an underlying issue. Patients may experience burning or pain, especially during urination or sexual activity, or they might notice unusual vaginal discharge. Constitutional symptoms, such as fever, general body aches, or malaise, may also be present, particularly with systemic infections or inflammatory conditions.
The presence of swollen, tender lymph nodes in the groin area is a sign that the body is actively fighting an infection or inflammation originating from the ulcer. Due to the varied causes, from minor irritation to serious infection, self-diagnosis is unreliable and can delay appropriate treatment. Any persistent, unexplained, or recurrent vulvar sore warrants medical attention.
A healthcare provider will perform a thorough visual examination and inquire about symptoms, medical history, and sexual history to narrow down the potential causes. Diagnosis often involves taking a swab of the ulcer base for viral or bacterial testing, blood tests to check for specific antibodies like those for syphilis, or in some cases, a small tissue biopsy. The correct treatment depends entirely on identifying the source of the ulceration.
Management and Treatment Approaches
The management plan for vulvar ulcers relies completely on the specific diagnosis confirmed by testing. If a viral cause like herpes simplex is identified, treatment involves oral antiviral medications, such as acyclovir or valacyclovir, which shorten the duration and severity of the outbreak. For bacterial infections, including syphilis, treatment typically involves a course of antibiotics, which are often curative.
Ulcers resulting from autoimmune or inflammatory conditions, such as Behçet’s disease or aphthous ulcers, are not treated with anti-infective drugs. Instead, they may be managed with topical or oral corticosteroids to reduce inflammation, or in more severe cases, with immunosuppressive therapies. Ulcers caused by trauma or irritants often heal on their own once the source of irritation is removed, but they may benefit from topical anti-inflammatory creams.
Regardless of the underlying cause, supportive care is important for symptom relief and preventing secondary infection. This includes using gentle hygiene practices, taking sitz baths with plain water to soothe the area, and applying topical anesthetics like lidocaine to manage pain. Over-the-counter pain relievers can also help reduce discomfort and inflammation while the body heals the ulcer.