Vulval Lesions

Vulval lesions are abnormal changes in the skin of the vulva that can appear as sores, ulcers, bumps, or patches. While many vulval lesions are benign and treatable, some may indicate serious conditions requiring prompt medical attention. Understanding the different types and their characteristics helps ensure appropriate evaluation and treatment.

⚠️ Seek Immediate Medical Care For:

  • Rapidly spreading lesions with fever
  • Severe pain with systemic symptoms
  • Signs of severe infection (pus, red streaks)
  • Bleeding that won't stop
  • Lesions with high fever and body aches
  • Difficulty urinating due to pain
  • Lesions following sexual assault
  • Severe swelling affecting daily activities

Definition and Overview

Vulval lesions encompass any abnormal skin changes on the external female genitalia, including the labia majora, labia minora, clitoris, and vaginal opening. These changes can manifest as ulcers (open sores), vesicles (fluid-filled blisters), papules (raised bumps), plaques (flat raised areas), or areas of color change. The appearance, location, and associated symptoms provide important diagnostic clues.

While discovering vulval lesions can be concerning, many causes are benign and treatable. Common causes range from infections and inflammatory conditions to trauma and allergic reactions. However, persistent or unusual lesions require medical evaluation to rule out serious conditions including sexually transmitted infections or, rarely, vulvar cancer.

Types of Vulval Lesions

Ulcers

  • Open sores
  • May be painful or painless
  • Single or multiple
  • Various depths
  • Clean or infected base
  • Different border characteristics

Vesicles/Blisters

  • Fluid-filled bumps
  • Clear or cloudy fluid
  • May rupture
  • Often grouped
  • Painful or itchy
  • Various sizes

Papules/Nodules

  • Raised solid bumps
  • Skin-colored or pigmented
  • Smooth or rough surface
  • Single or multiple
  • Various consistencies
  • May be tender

Patches/Plaques

  • Flat color changes
  • White, red, or dark
  • Smooth or scaly
  • Well or poorly defined
  • May be thickened
  • Can be itchy

Common Causes

Infectious Causes

  • Herpes simplex virus: Painful vesicles that rupture into ulcers
  • Human papillomavirus (HPV): Genital warts
  • Syphilis: Painless ulcer (chancre)
  • Molluscum contagiosum: Pearly bumps
  • Fungal infections: Red, itchy patches
  • Bacterial infections: Folliculitis, abscesses

Inflammatory Conditions

  • Lichen sclerosus: White patches, thinning skin
  • Lichen planus: Purple, itchy patches
  • Psoriasis: Red, scaly plaques
  • Eczema: Itchy, inflamed patches
  • Contact dermatitis: Allergic reactions
  • Hidradenitis suppurativa: Recurrent abscesses

Other Causes

  • Bartholin's cysts: Swelling near vaginal opening
  • Fordyce spots: Normal oil glands
  • Trauma: From injury or friction
  • Aphthous ulcers: Recurrent painful sores
  • Behçet's disease: Systemic condition with ulcers
  • Vulvar cancer: Persistent lesions

Associated Symptoms

Vulval lesions often occur with other symptoms:

  • Pain: Burning, stinging, or throbbing
  • Itching: Mild to severe
  • Vaginal discharge: Abnormal color or odor
  • Bleeding: From lesions or contact
  • Swelling: Local or generalized
  • Urinary symptoms: Pain, frequency
  • Lymph node swelling: In groin area
  • Fever: With infections

When It's Serious

Warning Signs

  • Lesions that don't heal within 2-3 weeks
  • Persistent or growing lesions
  • Painless ulcers (may indicate syphilis)
  • Irregular borders or multiple colors
  • Bleeding without trauma
  • Hard, fixed nodules
  • Recurrent lesions in same location
  • Associated weight loss or fatigue

Diagnostic Approach

Medical Evaluation

  • Detailed medical history
  • Sexual history
  • Visual examination
  • Palpation of lesions
  • Lymph node assessment
  • Full skin examination

Diagnostic Tests

  • Viral cultures: HSV, VZV
  • PCR testing: Viral detection
  • Blood tests: Syphilis, HIV
  • Biopsy: Persistent lesions
  • Wood's lamp: Fungal infections
  • Patch testing: Allergies

Treatment Options

Topical Treatments

  • Antiviral creams
  • Antifungal medications
  • Corticosteroid creams
  • Antibiotic ointments
  • Immunomodulators
  • Anesthetic gels
  • Barrier creams
  • Hormone creams

Oral Medications

  • Antiviral drugs
  • Antibiotics
  • Antifungals
  • Pain medications
  • Antihistamines
  • Immunosuppressants
  • Hormonal therapy
  • Systemic steroids

Self-Care and Management

  • Gentle cleansing: Mild, unscented soap
  • Keep dry: Pat dry, avoid moisture
  • Loose clothing: Cotton underwear
  • Avoid irritants: Perfumed products
  • Sitz baths: Warm water soaks
  • Pain relief: Cool compresses
  • Avoid scratching: Prevents infection
  • Safe sex practices: Until healed

Prevention

  • Safe sex: Barrier methods
  • Regular screening: STI testing
  • HPV vaccination: Prevents genital warts
  • Good hygiene: Gentle care
  • Avoid irritants: Known allergens
  • Manage conditions: Diabetes, immune issues
  • Regular check-ups: Gynecological exams
  • Prompt treatment: Early intervention

Related Symptoms

Vaginal Discharge

Often accompanies infections.

Vaginal Itching

Common with many conditions.

Pelvic Pain

May occur with infections.

Painful Urination

Common with vulval lesions.