Vulvar ulcers are open sores or lesions on the vulva, the external female genitalia. They vary in appearance, from small, shallow breaks to larger, deeper wounds, and can cause pain, itching, burning, or be painless. A vulvar ulcer is a symptom of an underlying health issue, not a standalone condition. Identifying the cause is necessary for effective management.
Infectious Causes of Vulvar Ulcers
Many vulvar ulcers stem from infectious agents, especially sexually transmitted infections (STIs). Herpes Simplex Virus (HSV), specifically HSV-1 and HSV-2, frequently causes painful, fluid-filled blisters that rupture into shallow, often multiple, ulcers. These lesions typically appear within a few days to two weeks after exposure and can be accompanied by flu-like symptoms.
Syphilis, caused by Treponema pallidum, manifests in its primary stage as a painless, firm, round chancre. This ulcer usually appears on the vulva three weeks after exposure. It often heals spontaneously within three to six weeks, even without treatment, but the infection persists and can progress. Chancroid, caused by Haemophilus ducreyi, produces painful, soft ulcers with ragged, undermined edges, often accompanied by swollen, tender groin lymph nodes.
Less common bacterial infections also cause vulvar ulceration. Lymphogranuloma Venereum (LGV), caused by specific Chlamydia trachomatis strains, initially presents as a small, often unnoticed papule or ulcer that quickly heals. This is followed by significant swelling and tenderness of groin lymph nodes, which may rupture and drain. Granuloma Inguinale (Donovanosis), caused by Klebsiella granulomatis, results in progressively enlarging, painless, beefy-red ulcers that bleed easily.
Inflammatory and Autoimmune Conditions
Some vulvar ulcers result from the body’s immune system activity or inflammatory processes. Behçet’s disease is a systemic inflammatory disorder characterized by recurrent, painful oral and genital ulcers, eye inflammation, and skin lesions. Genital ulcers in Behçet’s disease often resemble herpetic lesions but tend to be deeper and heal with scarring.
Crohn’s disease, an inflammatory bowel disease, can also cause vulvar ulcers. These might appear as deep, linear fissures, edematous labia, or fistulas, referred to as metastatic Crohn’s disease if occurring away from the gastrointestinal tract. Acute vulvar ulcers (Lipschütz ulcers) are typically non-sexually transmitted and appear as solitary or multiple painful ulcers, often in adolescent girls. These ulcers can be associated with systemic viral infections (e.g., Epstein-Barr virus) or other general illnesses, and usually resolve without specific treatment.
Chronic inflammatory skin conditions like lichen planus and lichen sclerosus can also lead to vulvar erosions or ulcers. Lichen planus can cause painful, purplish lesions that may erode, while lichen sclerosus presents as thin, white patches that can become fragile and prone to tearing or ulceration. These conditions require ongoing management to prevent complications and discomfort.
Other Potential Causes
Beyond infections and inflammatory conditions, other factors can lead to vulvar ulcers. Physical trauma, such as direct injury, friction from clothing, or vigorous sexual activity, can create a break in the skin that develops into an ulcer. These traumatic ulcers are often irregular and appear at the site of injury.
Certain medications can trigger severe skin reactions that manifest as ulcers. Fixed drug eruptions, for instance, can cause solitary or multiple red patches that blister and ulcerate upon re-exposure to a specific drug. More severe and rare drug reactions, such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), involve widespread blistering and detachment of skin and mucous membranes, including the vulva, leading to extensive ulcerations. These are medical emergencies requiring immediate attention.
Though less common, a vulvar ulcer can be a sign of malignancy. Vulvar cancer, such as squamous cell carcinoma or melanoma, can present as a persistent sore, lump, or ulcer that does not heal. These cancerous ulcers may be irregular in shape, have raised borders, or exhibit changes in color. Any non-healing or suspicious vulvar lesion warrants thorough medical evaluation to rule out malignancy.
When to Seek Medical Attention
Any new, unexplained, painful, or persistent vulvar ulcer warrants prompt medical evaluation. Seek professional advice if the ulcer is accompanied by other concerning symptoms, such as fever, swollen lymph nodes in the groin, general malaise, or unusual vaginal discharge.
Self-diagnosis of vulvar ulcers is unreliable due to the wide range of potential causes, some requiring specific treatments to prevent complications or transmission. A healthcare provider can accurately determine the underlying cause through a comprehensive approach, typically involving a physical examination, detailed medical history, and specific laboratory tests.
Tests may include swabs from the ulcer for viral or bacterial cultures, blood tests for systemic infections or autoimmune markers, or a biopsy of the ulcer tissue. A precise diagnosis is necessary for appropriate and effective treatment. Early intervention can prevent progression, alleviate discomfort, and mitigate the risk of transmitting infectious agents.