Vulvar ulcers are open sores on the vulva, the external part of the female genitalia. They represent breaks in the skin or mucous membranes, often beginning as bumps or rashes before breaking the surface.
Understanding Vulvar Ulcers
Their appearance can vary significantly; they might be single or multiple, ranging in size, and can sometimes present as shallow erosions or deeper lesions. Some ulcers may appear as fluid-filled bumps that rupture and crust over.
The symptoms associated with vulvar ulcers are diverse and depend on the underlying cause. Common manifestations include pain or discomfort, itching, and a burning sensation. Individuals may also experience painful or difficult urination, discomfort during sexual intercourse, or unusual discharge. Swelling in the affected area, enlarged lymph nodes in the groin, and fever can also accompany these ulcers.
Common Causes of Vulvar Ulcers
Vulvar ulcers result from inflammation and tissue damage, stemming from both infectious and non-infectious conditions. Sexually transmitted infections (STIs) are a frequent cause of these lesions. Herpes simplex virus (HSV), particularly types 1 and 2, often results in multiple painful ulcers from ruptured blisters. Syphilis typically presents as a single, painless sore with firm borders, while chancroid causes painful sores that may have irregular edges. Other STIs like chlamydia, lymphogranuloma venereum, granuloma inguinale, and HIV can also cause vulvar ulceration.
Beyond STIs, other infections can also trigger vulvar ulcers. Fungal infections, such as vulvovaginal candidiasis (yeast infection), can cause these lesions. Bacterial infections, including Group A Streptococcus or Mycoplasma, can also manifest as vulvar sores. Certain viral infections like Epstein-Barr virus, cytomegalovirus, or varicella zoster (chickenpox and shingles) may also lead to vulvar ulcer formation.
Non-infectious conditions contribute to vulvar ulcer development as well. Inflammatory and autoimmune diseases, where the immune system attacks healthy tissues, can cause these sores. Examples include Behçet’s disease, Crohn’s disease, and aphthous ulcers (similar to canker sores).
Skin conditions like lichen planus, psoriasis, or general dermatitis from irritation can also result in vulvar ulceration. Trauma from friction, scratching, or irritation from hygiene products and hair removal can physically damage vulvar skin, leading to ulcers. Rarely, vulvar ulcers may indicate the presence of certain cancers or be a reaction to specific medications.
Diagnosis and Treatment Approaches
Diagnosing vulvar ulcers typically begins with a thorough review of an individual’s medical history, including recent sexual activity and any new medications. A physical examination is then conducted to assess the appearance, size, and location of the ulcers, as well as to check for enlarged lymph nodes in the groin. The appearance alone can sometimes be misleading, so further investigation is often necessary.
To identify the underlying cause, various diagnostic tests may be performed. Swabs taken directly from the ulcer can be tested for viral infections like HSV or bacterial pathogens. Blood tests are commonly used to screen for STIs such as syphilis and HIV, and to check for markers of inflammatory conditions. In cases where the cause is unclear, or if the ulcer is persistent or atypical, a biopsy, which involves taking a small tissue sample for microscopic examination, might be recommended.
Treatment strategies for vulvar ulcers are tailored to address their specific cause. For infectious causes, this may involve antiviral medications for viral infections like herpes, or antibiotics for bacterial infections. Fungal infections are typically treated with antifungal agents.
Beyond treating the root cause, symptomatic relief is also important to manage discomfort. This can include oral pain relievers, topical creams or ointments to soothe the area, and sitz baths to promote healing and reduce pain. Maintaining good vulvar hygiene by gentle cleaning and avoiding irritants is also a component of care to support healing.
When to Seek Medical Care
It is important to seek medical attention for any new or persistent vulvar ulcers. Professional evaluation is advised if ulcers are accompanied by severe pain, begin to spread, or if there is a fever. Swollen lymph nodes in the groin or any unusual discharge are also signs that warrant a medical consultation.
Prompt medical assessment is important because self-diagnosis is often insufficient for vulvar ulcers. A healthcare provider can accurately identify the cause of the ulcers and recommend the most effective treatment plan, helping to prevent potential complications and ensure appropriate care.