Vulvar ulcers are sores that develop on the vulva, or the outside of the vagina. They can result from injury, irritation, or a sexually transmitted infection (STI).
Sexually transmitted infections (STIs) and several other conditions or activities can cause vulvar ulcers.
This article looks at the types, causes, and symptoms of vulvar ulcers. It also discusses how common they are, some potential complications, and how doctors diagnose and treat vulvar ulcers.
Vulvar ulcers are breaks in the skin around the vagina or mucous membranes of the vulva.
Ulcers typically take the form of sores or surface tissue damage.
Females can develop vulvar ulcers due to both sexual and non-sexual causes. For example, causes can include:
- sexual contact
- STIs
- injury to the vulva
- irritation of the vulva
If vulvar ulcers result from another cause, doctors may classify them as either acute reactive or acute recurrent.
Acute reactive ulcers tend to occur after certain illnesses that cause very painful sores. These sores usually resolve within a few weeks and do not return. They tend to develop in adolescent females, though they can also affect adult females.
Acute recurrent ulcers can recur continuously. Females may experience them at regular times, such as before menstruation, or only occasionally.
Recurrent ulcers are usually smaller than reactive ulcers, though they may also be numerous and large. They seem to develop in response to specific infections or autoimmune conditions.
Vulvar ulcers occur due to inflammation that causes tissue death. Both non-infectious and infectious conditions can cause vulvar ulcers.
Vulvar ulcers usually develop in response to STIs and often contain infective fluids or blood.
Some common STIs associated with vulvar ulcers
Non-sexually acquired vulvar ulcers can occur due to products or activities that irritate or damage the vulvar tissues.
Some common causes include:
- trauma, such as cuts, chafing, and scratches
- allergic reactions to ingredients in beauty, hygiene, or sexual products
- hair removal processes, such as shaving or waxing
Non-sexual-, non-trauma-related vulvar ulcers may be due to aphthosis. Aphthosis is a condition that causes recurrent ulcers on the mucous membranes of the mouth, lips, cheeks, and genitalia.
Less commonly, vulvar ulcers may occur due to excessive immune reactions, either because of inherited inflammatory conditions or certain infections, including:
- autoimmune conditions, such as Crohn’s disease or Behcet disease
- bacterial infections, such as group A streptococcal infections and mycoplasma
- acute infections, such as tonsillitis, upper respiratory infections, or conditions that cause diarrhea
- viral infections, such as Epstein-Barr virus, mumps, or HIV
- parasitic infections, such as toxoplasmosis
In some cases, vulvar ulcers do not cause any specific symptoms other than the sores themselves. Symptoms tend to depend on the cause and severity of the ulcers.
Most vulvar ulcers appear as painful lesions that may leak fluid or bleed. They may appear on the external layers of the female genitalia and the surrounding skin. Substantial swelling or inflammation may also accompany the ulcers.
Vulvar ulcers, and many of the STIs and other conditions associated with them, can cause additional symptoms. These include:
- pain or a burning sensation, especially during urination and intercourse
- itchiness
- rashes or raised bumps
- difficulty urinating
- foul-smelling discharge or unusual vaginal discharge
- swollen, tender lymph nodes in the groin
- fever
- gastrointestinal symptoms
- abnormal vulvar skin color changes
- pelvic pain
The true prevalence of vulvar ulcers is unclear, given that many cases go undiagnosed.
Some estimates claim that around 20 million people worldwide develop genital ulcers annually. According to other sources, roughly 20% of the population will experience aphthous ulcers.
STIs are the leading cause of vulvar ulcers. An estimated 50% of sexually active people will contract an STI by the age of 25.
Herpes simplex virus 1 and 2 (HSV 1 and HSV 2) seem to be the most common cause of genital ulcers in the United States, followed by syphilis and, more rarely, chancroid. Around 1 in 2 people in the U.S. aged 14–49 have an HSV 1 infection.
To diagnose vulvar ulcers, a doctor will typically ask the person questions about their:
- medical history
- symptoms
- lifestyle factors
- use of personal hygiene or cosmetic products
- sexual activity
Based on this information, the doctor will then order specific tests to confirm or rule out the presence of conditions, especially STIs such as
They may take urine samples or swabs of mucus or fluid from the ulcer. The doctor may also take blood samples to test for any nutritional deficiencies and blood abnormalities.
If they suspect a more complex or severe underlying condition, such as an autoimmune condition, they may refer the person to a specialist.
The treatment options for vulvar ulcers depend on the cause.
Vulvar ulcers that develop due to allergic reactions or tissue damage often resolve by themselves with time, proper hygiene, and care. Over-the-counter pain medications and topical products may also help reduce the pain and discomfort associated with vulvar ulcers.
More severe ulcers often require medical attention or additional care, such as dressings or gentle, regular cleaning, to encourage healthy recovery.
People with a bacterial infection, fungal infection, or STI may receive at least one course of oral antibiotics. A doctor may prescribe antiviral pills or shots to treat certain viral infections.
If underlying immune or inflammatory conditions are causing vulvar ulcers, a doctor may prescribe steroids or topical corticosteroids.
People with infections such as herpes and HIV often take daily medications indefinitely. This can prevent the symptoms and reduce the risk of transmitting the infection to others.
Like any sore, vulvar ulcers can become infected. Without treatment, this can cause complications ranging from mild fever to life threatening infections.
Vulvar ulcers can also cause scarring, discoloration, and reduced skin elasticity.
Without treatment, most STIs associated with vulvar ulcers can cause serious, and sometimes permanent, complications.
Every year, around 24,000 females become infertile due to an undiagnosed and untreated STI. Having an untreated STI also increases the risk of developing HIV.
Several STIs can cause certain types of cancer. For example, HPV is responsible for around 69% of vulvar cancers. In 2017, an estimated
Based on available research, white females in the U.S. have a higher risk of vulvar cancer.
Untreated chlamydia and gonorrhea can also lead to the development of pelvic inflammatory disease (PID). The Centers for Disease Control and Prevention (CDC) claim that
Most vulvar ulcers occur due to STIs, especially herpes and syphilis. Several autoimmune conditions, infections, activities, and lifestyle factors can also give rise to vulvar ulcers.
With proper care, vulvar ulcers often go away by themselves after a few weeks. Without treatment, however, some conditions and infections can cause recurring ulcers.
Vulvar ulcers can be painful, though they may not cause any specific symptoms.
Anyone with unexplained or severe vulvar ulcers should talk with a doctor as soon as possible to reduce the risk of serious complications.