Vaginal ulcers are open sores on the vaginal skin that can arise from various underlying conditions. This article explores the nature of vaginal ulcers, their causes, symptoms, and medical approaches to diagnosis and treatment.
Understanding Vaginal Ulcers
A vaginal ulcer is an open sore or lesion that develops on the vulva, the external female genitalia, and sometimes on the vaginal walls. These lesions can vary in appearance, from small bumps or rashes to pronounced breaks in the skin that may ooze fluid or pus. They might initially appear as minor bumps or a rash, progressing to open sores over time.
Ulcers are slow-healing wounds where the surface tissue breaks down, exposing deeper layers. While some vaginal ulcers may not cause noticeable symptoms, others can be painful. A vaginal ulcer is a physical manifestation or symptom, rather than a disease itself, pointing to an underlying condition.
Causes of Vaginal Ulcers
Vaginal ulcers stem from infectious and non-infectious causes. Sexually transmitted infections (STIs) are a common origin. Herpes simplex virus (HSV), particularly HSV-2, often presents as fluid-filled blisters that rupture into painful ulcers. Syphilis, caused by Treponema pallidum, leads to a painless, firm, and round ulcer known as a chancre during its primary stage. Other bacterial STIs like chancroid (Haemophilus ducreyi) and lymphogranuloma venereum (certain Chlamydia trachomatis serotypes) also result in painful ulcerations.
Other infections can also lead to vaginal ulcers. Fungal infections, such as vulvovaginal candidiasis, can cause ulceration alongside itching and burning. Certain bacterial infections, including Group A Streptococcus and Mycoplasma, may also trigger these sores. Viral infections like Epstein-Barr virus, cytomegalovirus, and varicella zoster virus (chickenpox and shingles) have also been linked to genital ulcers.
Non-infectious causes include autoimmune and inflammatory conditions such as Behçet’s disease, Crohn’s disease, systemic lupus erythematosus, and skin conditions like lichen planus and lichen sclerosus. Trauma, from sexual activity, chronic friction from tight clothing, or excessive scratching, can cause ulcers. Chemical irritants in soaps, douches, or personal care products, and reactions to certain medications (fixed drug eruptions), can also lead to ulcer formation.
Symptoms and When to Seek Medical Attention
Symptoms associated with vaginal ulcers vary by cause, but common indicators exist. Individuals may experience localized pain, burning, or itching. Discomfort during urination (dysuria) or sexual intercourse is common. Other symptoms include unusual vaginal discharge, which might have an unpleasant odor, or pus or fluid oozing from the sores.
Systemic symptoms can occur, particularly with infectious causes, such as swollen lymph nodes in the groin or a fever. Some ulcers may appear as small bumps that burst, leak fluid, and then crust over. Any new, unexplained, or persistent vaginal ulcer warrants prompt medical evaluation. Early diagnosis and treatment are important for effective management and to prevent potential long-term issues.
Diagnosis and Treatment Approaches
Diagnosing vaginal ulcers involves a medical assessment to identify the underlying cause. A healthcare provider will examine the ulcers and surrounding skin, and may also examine the lymph nodes in the groin. Gathering a detailed patient history, including sexual activity and any recent illnesses or exposures, is also important.
Laboratory tests confirm diagnosis. Swab tests collect samples from the ulcer for viral cultures or bacterial testing, identifying pathogens like herpes simplex virus or bacteria causing chancroid. Blood tests check for systemic infections such as syphilis or HIV. If the cause remains unclear, or if ulcers are persistent or unusual, a biopsy—where a small tissue sample is taken for microscopic examination—may be performed to rule out inflammatory conditions or, rarely, malignancy.
Treatment for vaginal ulcers depends on the identified cause. For viral infections like herpes, antiviral medications such as acyclovir, valacyclovir, or famciclovir reduce outbreaks. Bacterial infections, including syphilis and chancroid, are treated with specific antibiotics like penicillin G benzathine or azithromycin. If an inflammatory or autoimmune condition is the cause, corticosteroids may reduce inflammation. For ulcers from trauma or irritation, wound care, pain management, and avoiding irritants are necessary. Supportive measures, such as sitz baths, over-the-counter pain relievers, and wearing loose cotton underwear, can alleviate discomfort during healing.