A vulvar sore is any break, lesion, or ulceration on the external female genitalia, known as the vulva. Though often mistakenly called “vaginal” sores, most occur on the vulva or labia. These lesions represent a disruption of the skin barrier and can range from small, painful blisters to firm, painless ulcers. Because their cause can indicate anything from simple irritation to a chronic health condition, they must be properly evaluated by a medical professional.
Sexually Transmitted Infections
Sexually transmitted infections (STIs) are a frequent cause of genital sores, and the lesion’s appearance often provides important diagnostic clues. The Herpes Simplex Virus (HSV), typically HSV-2 or HSV-1, causes outbreaks beginning as a cluster of small, painful, fluid-filled blisters. These vesicles rupture, leaving shallow, red, and intensely painful ulcers that take time to heal. Initial outbreaks may also include systemic symptoms like fever, headache, and swollen lymph nodes.
The chancre of primary syphilis, caused by Treponema pallidum, is typically firm, round, and painless, often delaying detection. This highly contagious sore appears at the site of infection and usually heals spontaneously within three to six weeks, even without treatment. However, the infection remains active.
The Human Papillomavirus (HPV) rarely causes open ulcers, instead presenting as genital warts. These are flesh-colored, raised or flat lesions that may cluster in a cauliflower-like appearance. They are generally painless and represent a growth, not a break in the skin.
Non-Infectious Dermatological Conditions
Sores can result from chronic, non-contagious dermatological conditions that cause inflammation and skin fragility. Lichen Sclerosus is an autoimmune condition that causes the vulvar skin to become thin, white, and patchy, resembling tissue paper. This fragility makes the area susceptible to tearing and fissuring, which are small, painful linear sores occurring from minimal friction or trauma. Untreated Lichen Sclerosus can lead to scarring that alters the vulvar architecture.
Another inflammatory condition is Lichen Planus, which can manifest in the vulvar area as painful, burning sores and erosions. In some cases, it presents with a distinct white, lacy pattern on the vulvar skin or inside the mouth. The erosive form of Lichen Planus can be destructive, leading to discomfort and potential scarring. A rarer cause is Behçet’s Disease, a chronic inflammatory disorder characterized by recurrent, deep, and painful genital ulcers that often appear alongside painful oral ulcers.
Physical Irritation and Acute Trauma
Many vulvar sores result from external irritants or physical damage, rather than infection. Contact dermatitis occurs when the vulva reacts to an irritant or allergen, causing redness, itching, and inflammation. Common culprits include harsh soaps, fragranced detergents, spermicides, and certain hygiene products. The intense itching often leads to scratching and micro-tears that develop into open sores.
Acute trauma, friction, and minor injuries are also frequent causes of skin breaks. Aggressive sexual activity, tight clothing, or abrasive hair removal methods like shaving or waxing can directly damage the delicate vulvar skin. These minor cuts are easily contaminated by bacteria, which can lead to painful spots like folliculitis or localized ulcers. Eliminating the source of irritation often allows these non-infectious sores to heal quickly.
When to Consult a Healthcare Provider
Because the underlying causes of vulvar sores vary widely, professional medical evaluation is necessary for accurate diagnosis and effective treatment. Seek prompt medical attention for any lesion accompanied by systemic symptoms like fever, chills, or swollen lymph nodes.
Consult a provider if a sore is intensely painful, bleeds easily, or if you experience recurrent sores. Examination is also warranted if a sore does not show signs of healing within two weeks, or if it is accompanied by an unusual discharge.
Diagnosis typically involves a physical inspection, followed by specific tests depending on the suspected cause. This may include a swab of the lesion’s fluid for viral or bacterial testing, or a blood test to check for conditions like syphilis. Accurate testing is the only way to confirm the etiology and ensure the correct treatment is started.