Vulvar Ulcers Explained: Identify, Manage, and Prevent

Have you noticed a painful sore ‘down there’ and felt immediate worry or discomfort? You’re not alone—many women feel anxious when they find sores on the vulva (the external female genital area). These sores, known as vulvar ulcers, can be especially troubling because it’s often unclear if they’re due to a sexually transmitted infection (STI) or a non-sexual cause.

This article helps you clearly understand vulvar ulcers—covering symptoms, common causes, diagnosis, treatment options, and prevention tips to ease your concerns and guide you toward relief.

You might worry if it’s a sexually transmitted infection (STI) or something more serious. Learn more about different causes of female genital sores.

Main Causes for Vulvar Ulcers

The causes of vulvar ulcers are diverse and can be divided into infectious and noninfectious categories.

Infectious

• Sexually Transmitted Infections (STIs):

Common STIs causing vulvar ulcers include herpes simplex virus (HSV), syphilis, lymphogranuloma venereum (LGV), chancroid, HPV, and Donovanosis.

In the United States, HSV and syphilis are the most common of these.^[1]

• Non-Sexually transmitted infections

Common non-sexual causes include secondary bacterial infections,yeast infections, physical trauma (such as scratching or shaving), and allergies to products.^[2]

Non Infectious

• Autoimmune and Inflammatory Conditions

Autoimmune-related conditions that can cause vulvar ulcers include Behçet’s disease, Crohn’s disease, recurrent aphthous ulcers, and Lichen sclerosus.^[2]

• Drug reactions or adverse effects such as nonsteroidal anti-inflammatory drugs, antimalarials, angiotensin-converting enzyme inhibitors, beta blockers, lithium, salicylates, or corticosteroids
• Trauma
• Blistering diseases such as pemphigus and erythema multiforme
• Behçet’s disease
• Psoriasis
• Reiter’s syndrome (which causes ulcer, arthritis, and uveitis)
• Crohn’s disease
• Neoplasms (abnormal growths)

Recognizing Symptoms of Vulvar Ulcers

Vulvar ulcers can be challenging to identify because their appearance varies widely. They usually start as small bumps, sores, or rashes on the vulva, and their characteristics depend on the underlying cause.

Common symptoms you might notice include:

• Painful or painless open sores on the vulva
• Bleeding or unusual discharge from the sores
• Swelling or redness around the sores
• Burning sensation during urination or intercourse
• Swollen glands in the groin (lymph nodes)
• Fever (in cases of infection)

Ulcer characteristics can differ based on specific infections:

• Herpes simplex virus (HSV): Usually causes multiple painful, shallow ulcers resulting from ruptured blisters.^[1]
• Primary syphilis: Typically appears as a single painless sore with a firm, raised border (chancre).
• Chancroid: Generally presents as painful sores with irregular edges and possibly pus-filled centers, often with noticeable swelling in nearby glands.

It’s important to remember some vulvar ulcers may initially appear without pain. Regardless, any persistent or concerning sores should prompt a consultation with your healthcare provider.

Vulvar ulcers are significant because they increase the risk of sexually transmitted infections (including HIV) and, if persistent, may indicate more serious conditions requiring prompt attention.^[3]

How Doctors Diagnose Vulvar Ulcers

Diagnosing vulvar ulcers can be challenging because their appearance varies depending on the cause. Some may be painful, red, and inflamed, while others are painless and firm.

Doctors use a combination of methods to identify the cause, including:

• Medical history – A doctor may ask about recent sexual activity, medical conditions, or any new medications.
• Physical examination – The size, shape, and texture of the ulcer are assessed.
• Laboratory tests – Swabs, blood tests, or skin samples may be used to detect sexually transmitted infections (STIs), bacterial infections, or autoimmune diseases.

Common Causes and Their Diagnostic Signs

• Genital Herpes (HSV) – Painful, shallow ulcers often diagnosed by visual examination or an HSV DNA test.^[1]
• Syphilis – Usually appears as a single, painless sore (chancre) and is confirmed with a blood test.^[1]
• Chancroid – Painful, irregular ulcers with pus-filled centers, diagnosed by lab culture.^[3]

If vulvar ulcers persist, cause significant discomfort, or are accompanied by other symptoms such as fever or swollen lymph nodes, seeking medical attention is essential. A proper diagnosis ensures appropriate treatment and reduces the risk of complications.

Effective Treatments for Vulvar Ulcers

Vulvar ulcers can result from many different causes—not only sexually transmitted infections (STIs). Due to this complexity, healthcare providers often initially treat genital ulcers as if they were STIs to effectively manage symptoms and reduce transmission risks. This strategy is endorsed by the World Health Organization (WHO) and various health authorities.^[1]

However, initial treatment may not always resolve the issue, especially if the underlying cause is noninfectious. It’s essential to seek further medical evaluation if symptoms persist.^[1],[2]

Treatment by Specific Causes

Herpes Simplex Virus (HSV)

Early antiviral treatment for HSV is crucial, even before test results are available, because it:

• Reduces symptom duration^[1]
• Lowers transmission risk^[1]

Patients should avoid sexual activity:

• At the earliest symptoms (tingling or itching)
• When sores are visible
• Until fully healed

Antiviral treatments typically involve oral medications. Topical antiviral creams have limited benefit and are generally not recommended.^[2]

Primary Syphilis

• Usually treated effectively with an intramuscular injection of penicillin.^[1]
• For those allergic to penicillin, CDC recommends a desensitization procedure.^[1]

Chancroid

• Treatment typically includes either oral antibiotics or an antibiotic injection.^[3]
• Sexual partners should also be treated if they’ve had recent sexual contact, even without symptoms, to prevent reinfection.^[3]

Lymphogranuloma Venereum and Donovanosis

• Both conditions respond well to oral antibiotics.
• Donovanosis treatment may continue until symptoms are completely resolved.

Behçet’s Disease

• Treatment focuses on managing symptoms, as genital ulcers may improve spontaneously.^[2]
• Medications, including subcutaneous injections, can reduce ulcer frequency and pain.^[2]
• Topical treatments like vaginal sucralfate may relieve pain but don’t significantly impact ulcer duration or frequency.^[2]

General Wound Care Recommendations

For extensive or persistent genital ulcers, general wound care may include:

• Regular gentle cleansing^[2]
• Application of appropriate dressings^[2]

Additional symptom-relief strategies:

• Oral or topical pain relievers (analgesics)^[2]
• Anti-inflammatory medications^[2]
• Sitz baths (warm perineal baths)^[2]
• Cool compresses with Burow’s solution^[2]

Certain topical antimicrobials (e.g., gentamicin, benzoyl peroxide, silver sulfadiazine) might help ulcers outside the genital area, but limited evidence supports their effectiveness specifically for vulvar ulcers.^[2]

Special Considerations for HIV-Positive Individuals

Prompt treatment of genital ulcers is particularly important for individuals with HIV, as it:

• Decreases HIV viral shedding
• Significantly reduces the risk of transmitting HIV to sexual partners

Genital ulcers increase HIV concentrations in genital secretions, making transmission more likely during sexual contact. Those with ulcers also have a higher risk of contracting HIV through unprotected sex.^[4]

When Immediate Medical Attention is Necessary

It is important to seek prompt medical consultation in the following situations:

• Rapidly worsening sores
• Severe pain
• Systemic symptoms such as fever or swollen lymph nodes^[1],[2]
• Sores lasting more than a week^[1]
• Recurring sores^[2],[3]
• Difficulty eating or chewing^[2]
• Signs of infection, such as pus, worsening redness, or spreading inflammation^[1],[3]
• New lumps that won’t heal^[2]

Potential Complications

If vulvar ulcers remain untreated, there are several potential risks:

• Severe infections
• Scarring
• Increased risk of STI transmission
• Possible infertility due to untreated infections
• Post-inflammatory hyperpigmentation, which may fade over months

Prevention Tips for Vulvar Ulcers

Preventing vulvar ulcers involves a combination of practices aimed at reducing the risk of infections and minimizing irritation to the vulvar area. Key preventive measures include:

Practice Safe Sex

• Limit your number of sexual partners.
• Always use condoms during sex.
• Regularly screen for sexually transmitted infections (STIs) based on your doctor’s advice.^[1],[3]

Maintain Good Hygiene

• Gently cleanse your genital area with mild, fragrance-free products.
• Keep the area dry, especially after showering or physical activity.

Avoid Irritants and Allergens

• Choose hypoallergenic personal care products.
• Avoid scented pads, tampons, sprays, and tight synthetic clothing.^[2]

Regular STI Screening & Counseling

• Screening for syphilis is recommended for individuals at higher risk.^[1]
• Routine HSV screening is generally not advised if you have no symptoms.^[3]
• HIV testing is critical for those experiencing genital ulcers, especially linked to syphilis, chancroid, or herpes simplex virus (HSV).^[4]

HSV Transmission Prevention

• Avoid sexual contact during active HSV outbreaks.
• Condoms reduce but do not fully eliminate the risk, as HSV can spread through skin-to-skin contact in uncovered areas.
• If your partner has HSV, consider specific serologic testing and get professional advice on protective measures.

Preventive Treatment for HSV

• Daily antiviral medications can reduce HSV outbreak frequency, severity, and lower transmission risks significantly.^[1],[4]

HSV Prevention During Pregnancy

• Pregnant women with HSV should begin preventive antiviral therapy between 34–36 weeks gestation to reduce recurrence and the risk of neonatal herpes, potentially decreasing the need for cesarean delivery due to HSV lesions.^[4]

Medical Disclaimer:
This article provides general information and does not replace professional medical advice. Always consult your healthcare provider for personalized guidance.