Vulvar Sore: Causes of Sores and Lesions on the Vulva

What a vulvar sore can look like

The vulva includes the outer and inner lips (labia majora and minora), the clitoris and its hood, and the entrance to the vagina. Sores here can take several forms, and the description helps narrow the cause:

• Blisters: small fluid-filled bubbles, often in clusters, that burst and leave shallow sores. Typical of herpes.
• Ulcers: open sores with a base. Painful ulcers suggest herpes, Behçet's or chancroid; a painless, clean, firm ulcer suggests syphilis.
• Fissures and cracks: splits in the skin, often from friction, yeast infection, eczema or lichen sclerosus.
• Bumps: ingrown hairs, folliculitis, cysts, warts or molluscum.
• Patches: white, red or dark areas that may itch, which can be skin conditions or precancerous changes.

Common causes of sores on the vulva

Genital herpes

Genital herpes is the most common cause of painful vulvar ulcers. A first outbreak often brings tingling or burning, then clusters of small blisters that break into shallow, very painful sores, with fever, aches, burning when urinating and swollen groin glands. It heals in 2 to 4 weeks. Recurrences are milder and shorter, usually 5 to 10 days, and often start with tingling in the same area.

Friction, shaving and minor injuries

Shaving cuts, waxing, tight clothing, cycling and sex without enough lubrication can cause small abrasions. These are tender but heal within a few days if kept clean and dry.

Ingrown hairs, folliculitis and boils

Red, tender bumps around hair follicles, often with a white head, are folliculitis. A larger, very painful lump filled with pus is a boil. Warm compresses help. Boils that do not drain or keep returning may need a doctor.

Bartholin cyst or abscess

The Bartholin glands sit at each side of the vaginal opening. A blocked gland forms a painless cyst. If infected, it becomes a hot, swollen, very painful abscess that makes sitting and walking difficult and usually needs drainage.

Skin conditions

• Lichen sclerosus: white, thin, crinkly or shiny skin with intense itching, bruising, cracks and sores. It is common after menopause and needs strong steroid ointment and long-term follow-up because it slightly increases cancer risk.
• Lichen planus: raw, red erosions, sometimes with lacy white edges, often also in the mouth.
• Eczema, contact dermatitis and yeast infection: itching and redness, with cracks or sores from scratching.

Other infections

• Syphilis: a single painless, firm ulcer (chancre) about 3 weeks after exposure. It heals by itself in 3 to 6 weeks, but the infection continues. A blood test is essential.
• Chancroid: painful, ragged ulcers with tender swollen glands. Rare in the US.
• Lymphogranuloma venereum and granuloma inguinale: rare STIs causing ulcers and gland swelling.
• Lipschütz ulcer: sudden painful ulcers in young women, often after a viral illness such as Epstein-Barr virus (glandular fever), not sexually transmitted.
• Shingles and hand, foot and mouth disease can occasionally affect the vulva.

Behçet's disease and Crohn's disease

Behçet's disease causes recurring painful mouth ulcers and genital ulcers, sometimes with eye inflammation and skin lesions. Crohn's disease can rarely cause vulvar swelling and ulcers.

Vulvar cancer and precancer

Vulvar cancer is uncommon and mostly affects women over 60, though HPV-related forms occur in younger women. Signs include a lump, ulcer or thickened patch that does not heal, long-standing itching, bleeding unrelated to periods, and white, red or dark patches. Vulvar intraepithelial neoplasia (VIN) is a precancerous change that can be treated before cancer develops.

Painful vs painless vulvar ulcers

How a vulvar lesion is diagnosed

A doctor, sexual health clinic or gynecologist will ask about sexual partners, recent illness, itching, previous episodes and mouth ulcers, and examine the vulva and groin glands. Tests can include:

• a PCR swab of the sore for herpes, ideally within the first few days
• a syphilis blood test, plus HIV and other STI tests
• a swab for bacteria or yeast
• a biopsy under local anesthetic for sores that do not heal, unusual patches or suspected lichen sclerosus or cancer

Do not apply creams for a day before an appointment if possible, as this can affect swabs.

Treatment and care for vulvar sores

Soothing care at home

• Bathe in plain warm water or a shallow salt bath and pat dry. Avoid soaps, bubble baths and scented products.
• Wear loose cotton underwear.
• Pour water over the area while urinating, or urinate in a warm bath, if it stings.
• Use a cold pack wrapped in cloth for short periods.
• Take acetaminophen (paracetamol) or ibuprofen for pain, following the label dose.
• A local anesthetic gel such as lidocaine can ease pain, but stop if it irritates.
• Avoid sex until sores heal.

Medical treatment

• Herpes: antiviral tablets shorten the outbreak if started early. Frequent recurrences can be prevented with daily suppressive treatment.
• Syphilis and chancroid: antibiotics, with treatment of partners.
• Lichen sclerosus and lichen planus: strong steroid ointment.
• Bartholin abscess: drainage, sometimes with a small catheter or marsupialization.
• Behçet's disease: topical steroids, colchicine or other immune treatments.
• Precancer or cancer: surgery or other specialist treatment.

Frequently asked questions

What causes sores on the vulva?

The most common causes are genital herpes, friction or shaving injuries, ingrown hairs, folliculitis and Bartholin abscesses. Skin conditions like lichen sclerosus, other STIs such as syphilis, Behçet's disease and, rarely, vulvar cancer are other causes. A swab and blood tests usually identify the cause.

Is every vulvar sore an STI?

No. Many vulvar sores come from shaving, friction, ingrown hairs, skin conditions or non-sexual infections. Lipschütz ulcers in young women often follow a viral illness. Because herpes and syphilis are common and treatable, testing is still the best way to be sure.

How long does a vulvar sore take to heal?

A minor cut heals in a few days. A first herpes outbreak takes 2 to 4 weeks, and recurrences 5 to 10 days. A syphilis sore heals in 3 to 6 weeks even without treatment, but the infection remains. Any sore not healing within 2 to 3 weeks needs a doctor.

Can a painless sore on the vulva be serious?

Yes. A painless, firm ulcer is the classic sign of syphilis, which must be treated with antibiotics. A painless lump or sore that does not heal can also be a sign of vulvar cancer, especially in older women. Both need prompt testing.

What is a vulvar lesion?

A vulvar lesion is any abnormal area on the vulva: a sore, ulcer, blister, lump, wart, or a white, red or dark patch. Lesions range from harmless cysts to infections and skin conditions, and rarely precancer or cancer. Persistent lesions are often biopsied to confirm the cause.

Should I see a doctor for a sore on my labia?

Yes, if it is painful and blistering, painless and firm, lasts more than 2 to 3 weeks, keeps coming back, or comes with fever, discharge or swollen glands. Minor shaving cuts that are clearly healing can be watched at home.