The vulva refers to the external female genitalia, including the labia majora, labia minora, clitoris, and the openings of the urethra and vagina. A vulvar lesion is defined as any area of abnormal tissue, such as a change in color, texture, or the presence of a bump, blister, or sore. These lesions represent a diverse range of conditions, from common irritations and infections to chronic skin disorders and, rarely, malignancies. Understanding the appearance (morphology) and cause (etiology) of these changes is key to recognizing when medical evaluation is necessary.
Categorizing Vulvar Lesions by Appearance
Classification of a lesion often begins with its physical characteristics, or morphology, which provides clues to the underlying condition. Flat, non-raised areas are described as macules if they are less than one centimeter, or patches if they are larger, indicating a change in skin color or texture without a change in elevation. These discoloration changes can range from white or pale areas, such as those seen in lichen sclerosus, to dark, pigmented spots that may be benign moles or, less commonly, melanoma.
Raised, solid lesions are typically categorized as papules, which are small bumps less than one centimeter, or nodules, which are larger and often extend deeper into the skin. Papules and nodules can represent various conditions, including benign growths like skin tags or fibromas, or they may be the warty, cauliflower-like growths associated with Human Papillomavirus (HPV) infection. Fluid-filled lesions are described as vesicles if they are small blisters, or bullae if they are larger than one centimeter, and these often characterize certain viral infections or autoimmune blistering diseases.
Open sores are classified as ulcers, which involve a complete break in the skin’s surface and expose underlying tissue, or erosions, which are more superficial breaks that do not extend through the full thickness of the skin. Ulcers are often painful and can be caused by infectious agents like the herpes simplex virus (HSV) or by systemic inflammatory conditions. When a lesion is broad and raised with a flat top, it is called a plaque, and these are often seen in chronic inflammatory skin conditions like lichen simplex chronicus or psoriasis. It is important to remember that appearance alone is not enough for a diagnosis, as many different causes can produce similar-looking lesions.
Primary Causes of Vulvar Lesions
Vulvar lesions arise from causes grouped into infectious, inflammatory, traumatic, and neoplastic categories. Infectious causes are common and include viral agents, such as Human Papillomavirus (HPV), which results in genital warts, and herpes simplex virus (HSV), which causes painful, recurrent ulcers. Fungal infections, such as vulvovaginal candidiasis, cause irritation and erosions, while bacterial infections like syphilis or chancroid present as distinct ulcerations.
Many lesions stem from non-contagious inflammatory and dermatological conditions. Lichen sclerosus is a chronic disorder that typically presents as white, thin, and parchment-like patches, often causing intense itching and pain. Contact dermatitis, either irritant or allergic, is a common reaction to soaps, detergents, or topical products and manifests as redness, swelling, and itching. Other autoimmune conditions, such as erosive lichen planus, can cause persistent, painful erosions on the vulva.
Traumatic and structural causes include common occurrences like ingrown hairs, which form a painful, localized nodule, and various types of cysts. Bartholin’s gland cysts develop near the vaginal opening when the duct becomes blocked, leading to a fluid-filled swelling that may become infected and form an abscess. Hematomas, or collections of blood under the skin, can also occur following trauma to the area.
Neoplastic causes—abnormal tissue growths—are less frequent but must be considered, as they can be benign or malignant. Benign tumors include fibroepithelial stromal polyps and hemangiomas. Vulvar intraepithelial neoplasia (VIN) is a precancerous condition, often linked to HPV, where abnormal but non-invasive cells appear on the skin’s surface, sometimes presenting as changes in color or texture. Vulvar cancer is typically a squamous cell carcinoma and may appear as a persistent lump, wart-like bump, or a non-healing sore; the risk increases with age and a history of chronic skin conditions like lichen sclerosus.
Seeking Medical Evaluation and Diagnosis
Any new or changing vulvar lesion should prompt a consultation with a healthcare provider, especially if “red flag” symptoms are present. These concerning signs include rapid growth, a lesion that fails to heal after several weeks, persistent bleeding unrelated to menstruation, or unresolved pain. Unexplained, chronic itching, particularly if unresponsive to over-the-counter treatments, also warrants medical attention, as it is a common symptom of inflammatory disorders and precancerous changes.
The diagnostic process begins with a detailed review of medical history and a visual examination of the vulva. The clinician may use a magnifying instrument called a colposcope (or vulvoscope) to examine the lesion in greater detail. This magnified view helps the doctor identify subtle changes in the skin’s surface and determine the most appropriate next step.
A definitive diagnosis often requires a vulvar biopsy, a minor procedure where a small tissue sample is removed for microscopic analysis. This is important for persistent, suspicious, or non-healing lesions to rule out precancerous or cancerous conditions. Different biopsy techniques, such as a punch biopsy which removes a small core of tissue, are used depending on the size and location of the lesion. Patients are advised against self-diagnosis or attempting to treat the lesion without professional guidance, as correct management depends entirely on the accurate identification of the underlying cause.