Female Genital Sores: Causes, Symptoms and Treatment

Genital sores in females can be an uncomfortable topic, but it is more common than you might realize. Female external genitalia consist of several parts, including mons pubis, labia majora and minora, clitoris, vulvar vestibule, urethral meatus, vaginal introitus, and some glands like Bartholin’s and Skene’s vestibular glands. Genital sores can appear in any of these areas.^[1] While female genital sores have many causes like sexually transmitted infections (STI), inflammation, or simply irritation, only some of these conditions pose serious risk. And the good news is, most of them are benign and would not cause significant harm to you.^[2] Therefore, the correct identification is essential to avoid undue anxiety and get an effective cure. Today we bring you essential insights to genital health, that will help you stay informed, proactive, and comfortable in caring for your health.

Symptoms of female genital sores

You may experience different symptoms depending on the underlying condition. However, most commonly seen complaints are,

• Itching, pain, burning sensation
• Blisters, open sores, or ulcers
• Vaginal discharge
• Pain during urination or sexual intercourse

STIs causing vaginal sores

While all genital sores are not STIs, a considerable proportion of them are caused by STIs like gonorrhea, chlamydia, syphilis, or trichomonas. Luckily, each STI causing vaginal sores have a set of other symptoms that would help you uncover the true culprit, putting a stop to unnecessary worries.

1. Genital Herpes (HSV)

Caused by the virus HSV-2, genital herpes appears as painful ulcers or sores with crusts around the genital area, swelling of the vulva and pain when passing urine.^[3] Burning pain of the ulcers is the most prominent feature, which is almost invariably present.

You can also have other associated symptoms like swollen lymph nodes, fever, headache and generalized body discomfort. However, the disease stays in the body for a long time, while the sores appear only at times which are called ‘outbreaks’. Proper treatment can help keep the outbreaks under control, letting the affected people live a near normal life.

2. Syphilis

Syphilis is caused by the bacteria Treponema pallidum. It has several stages, (primary, secondary, latent, and tertiary) and the vaginal sores appear in the primary stage. Syphilis ulcer ‘chancre’ is usually painless. It starts as a small firm bump (a papule) on the vulva. Sometimes it might appear in the inner genital tract as well, especially on the cervix, in which case it may go unnoticed because of its painless nature. Bump can then become ulcerated and hardened with raised edges and smooth base without any pus. Typically, the chancre is 1 to 2 cm in size. They can go away on their own in 3 to 6 weeks leaving behind only some scarring.^[4]

3. Chancroid

Rarer than both conditions above, chancroid appears as a result of Haemophilus ducreyi bacterial infection. It is worth noting how similar the ulcer can be to other more common conditions. They appear on labia and perineal are. Most prominent feature of the chancroid is the extreme pain. These painful genital ulcers can also have a soft irregular margin and a crumbly bases with yellow-grey pus and easy bleeding.^[5] This earns the name ‘soft chancre’, highlighting the similarity and the difference between the syphilis chancres and chancroids.

4. Molluscum Contagiosum

Molluscum Contagiosum is a viral disease, causing characteristic round dome shaped skin-colored lesions, with a pearly appearance and a small dip in the center of the papule known as ‘central umbilication’.^[6] Because of this special appearance, they are also called ‘water warts’. Varying in size from 1mm to 1cm, they can be itchy and painful. Furthermore, when these water warts appear, there will be about 20 lesions grouped or scattered over inner thighs, vulva or around the anus.^[6]

5. Granuloma Inguinale (Donovanosis)

The bacteria Klebsiella granulomatis is the culprit responsible for Granuloma Inguinale. When the lesions first appear, they are painless bumps or nodules under the skin. But they soon turn into ulcers with lots of blood vessels, giving the ulcer a characteristic ‘beefy red’ appearance. It would bleed heavily even with a small trauma, and lesions can spread outwards creating mirror-image new lesions at skin folds with snakelike edges.^[7]

6. Lymphogranuloma Venereum (LGV)

LGV is caused by the bacteria Chlamydia trachomatis. While uncommon, identification and treatment are important because of the serious complications that can occur otherwise. The disease has 3 stages and the ulcers appear in the very first. Small bumps or ulcerated lesions of 1mm-6mm size with no other symptoms apart from occasional redness and swelling are the prominent features.^[8] They go away on their own in a few days, therefore, most people do not even notice the first stage of LGV. Second stage has more generalized symptoms like fever which brings attention to the illness.

Causes of Female Genital Sores Due to Non-STI Conditions

Genital sores are not always caused by infections or sexually transmitted diseases. They can also come from skin conditions or allergies. Some systemic skin conditions might also manifest as genital sores, making the correct identification a priority.

7. Atopic Dermatitis and Contact Dermatitis

Dermatitis is inflammation and irritation of the skin because of various triggers. These triggers range from hot showers, products like soaps, synthetic fabrics to some food items.^[9] Coming into contact with anything that causes allergic reaction in your skin gives rise to contact dermatitis. Red itchy dry skin around the vagina which later becomes thickened and leathery can cause serious discomfort.

8. Hidradenitis Suppurativa

Hidradenitis suppurativa is a long-term skin condition that causes painful lumps under the skin, including nodules, abscesses, and tunnels that can scar over time.^[10] Apart from these, it can become a big nuisance to your day today life due to the pain, oozing and unpleasant smell from the sores, leading to anxiety and social withdrawal.

9. Folliculitis

Folliculitis is inflamed hair follicles that can appear as red, tender bumps around the genital area, especially after shaving or waxing. This common condition happens when hair follicles become irritated or infected, forming small pustules or red bumps around the hair follicle.^[11] It is usually not serious and often clears up on its own. While bacteria are the commonest cause, it can also be caused by fungi, viruses, or even non-infectious things like skin friction or irritation.

10. Psoriasis

Psoriasis is a long-term skin condition that appears over many places in the body, including the groin area. Genital psoriasis falls under the sub-type labeled ‘flexure psoriasis’ appearing as smooth, red, and sharply demarcated patches. The skin can become damp, softened, and may develop small cracks. This can lead to an unpleasant smell, itching, or both.^[12] Differentiating it from more common fungal infections can be difficult for an untrained person, because of the similar appearance.

11. Behcet’s Disease

Behçet’s disease is a rare inflammatory condition that affects blood vessels, causing recurring mouth and genital sores, red nodules and vision problems ultimately leading to blindness. Genital sores appear in over 80% of those affected, mostly on the vulva or vagina in women, and often heal with scarring.^[13] The exact cause of Behçet’s is still unknown.

12. Cysts or Abscesses

Bartholin’s gland is a gland in the vulva that helps to keep the area lubricated. The obstruction of the opening of these glands can lead to secretions to build up inside the gland, getting infected by bacteria, finally forming a pus-filled nodule or a cyst.^[14] They can become larger the longer you wait, and get increasingly more painful.

Diagnosis of Female Genital Sores

The appearance and symptoms can only give you some clues as to what you have. The correct identification might take a touch of expertise and some tests as well, which is why you should not hesitate to go to a medical professional with any genital sores that are bothersome to you. They will take a detailed history, including your recent sexual history. Depending on the necessity, they might do a pelvic examination to inspect assess the sores, take blood to test for STIs like syphilis or HIV, do swab tests to identify bacterial or viral causes, and possibly a biopsy for further analysis.

Treatment Options for Female Genital Sores

Mode of treatment differs according to the disease condition identified. You might be given tablets, local applications or offer of simple surgery in some instances like Bartholin’s cyst. Bacterial conditions like syphilis or chancroid will be treated with antibiotics, while viral infections like herpes will be managed with antiviral drugs. Antifungal treatments address fungal-related sores, and topical creams are effective for skin conditions such as dermatitis or psoriasis.

It is very important to treat the sexual partners as well, regardless of whether they have the symptoms or not. This is because the potential of the disease within the body without any outward manifestations, and the ability of these asymptomatic people to spread the disease to another unknowingly.

Prevention of Genital Sores

Safe sex is the number one method of preventing female genital sores, as most of them are STI related. Barrier methods like condoms can give you protection against STIs, even though not 100% reliable. Routine screening tests are a good method to identify infected people before any ulcers appear, and this will prevent asymptomatic spread of the disease to others as well. Good genital hygiene and avoidance of harsh products help preventing certain inflammatory conditions and the progress of the ulcers into something more severe.

Shaving and vaxing commonly cause folliculitis and irritation of the skin, giving rise to a lot of non-STI genital sores. Therefore, trimming pubic hair instead of shaving can save you from a lot of unnecessary trouble as well.

When to See a doctor

It is important to see a healthcare professional if you notice any new sores that are painful, do not heal, or change in size. Additionally, seek medical attention if you experience other concerning symptoms like fever, lower abdominal or groin pain, or unusual vaginal discharge, as these could indicate a more serious condition. If you have a history of STIs and develop new symptoms, it is crucial to consult a doctor promptly. Taking these simple steps ensures you receive timely diagnosis and treatment, which is essential for maintaining sexual health and preventing complications.

Outlook and Long-Term Care

Most of the time, you can achieve full recovery with early diagnosis and correct treatment for the necessary duration. But unfortunately, some conditions like genital herpes will persist life long as there is no definite cure.^[3] However, with correct medications the symptomatic outbreaks can be kept at bay, and reduce the risk of disease spreading to others, allowing you to enjoy a normal life. Therefore, long term follow-up in such long-term conditions is beneficial to you and the society as a whole.

It is a well-known fact that there is a certain amount of stigma associated with problems regarding to genital health. But as we discussed, a genital sore is not always a STI, and even if it is, there is treatment available to completely get rid of it. Do not let the society make your life miserable, get your genital lesions checked right away to achieve full recovery, and live a fulfilling life in every aspect!

Frequently Asked Questions about  Female Genital Sores

1. What are the most common causes of female genital sores?

While a wide range of causes give rise to female genital sores, STIs are the leading cause worldwide. Herpes simplex virus and syphilis are two such common STIs identified. In addition, non-sexual causes including infections like folliculitis and abscesses, inflammatory causes like flexure psoriasis, and atopic causes like dermatitis are not rare.

2. How can I tell if my genital sores are due to an STI?

Some STIs give rise to characteristic lesions, which is helpful in identification. For example, syphilis present with the characteristic ‘chancre’, a painless hard ulcer with a clean base and raised margins. Some conditions (eg. Molluscum contagiosum) are diagnosed purely based on the look of the lesion. Accompanying symptoms and recent sexual history will also give a clue as to whether your genital sore is likely to be due to STI. You can get to know for sure if you go and meet your healthcare provider, who can assess the ulcer and perform some tests to confirm the suspected condition.

3. Can home remedies help with female genital sores?

While home remedies are unlikely to provide you definitive cure, they can help you with symptoms like pain and discomfort. Warm compresses can soothe irritation, and aloe vera may help reduce pain with its cooling effect. It is important to do these remedies in a hygienic manner because otherwise it can lead to bacterial infections and worsening of the genital sores. Also, remember that these are just temporary solutions, and you should get proper treatment as early as possible for good outcomes.  

4. Are genital sores always contagious?

No, genital sores are not always contagious. Contagiousness depends on the underlying cause. Ulcers due to STIs are contagious, especially during the symptomatic periods of STIs of chronic nature. Non STI causes like folliculitis, genital psoriasis, dermatitis, Hidradenitis Suppurativa, Behcet’s Disease, Bartholin’s cysts and abscesses are not spread from person to person.