A vaginal lesion is a broad term describing any abnormality on the skin or mucous membranes of the vulva or vagina, including bumps, sores, ulcers, or growths. These physical changes are symptoms of an underlying process, signaling that the body’s normal tissue integrity has been disrupted. The causes for these manifestations range widely, from common, temporary irritations to chronic skin disorders and, in rare instances, malignancy. Understanding the appearance and context of the lesion can offer initial clues, but a professional evaluation is necessary to accurately determine the specific cause. This evaluation is important because the appearance of the lesion often provides limited information about its origin, which could be infectious, inflammatory, or traumatic.
Lesions Caused by Infections
Infectious agents are a major cause of lesions in the genital area. One of the most recognized viral causes is the Herpes Simplex Virus (HSV), which presents as small, painful clusters of fluid-filled blisters. These blisters eventually rupture, leaving shallow, often tender ulcers that crust over and heal within a few weeks. The recurrent nature of HSV lesions is a distinguishing feature, with subsequent outbreaks typically milder and shorter than the initial episode.
Another significant viral cause is the Human Papillomavirus (HPV), responsible for genital warts. These growths are typically flesh-colored, raised, and can cluster together, sometimes appearing cauliflower-like. Unlike herpetic ulcers, HPV warts are usually painless, though they may cause minor discomfort depending on their size and location. These lesions result from the virus causing an overgrowth of cells in the outer layer of the skin or mucous membrane.
Bacterial infections also cause ulcerative lesions. Syphilis, in its primary stage, manifests as a chancre—a single, firm, and characteristically painless ulcer with clean edges. This lack of pain often means the lesion goes unnoticed. Other bacterial infections, such as Chancroid, cause the opposite presentation, leading to ulcers that are ragged, deep, and extremely painful.
While not typically causing primary lesions, common fungal and bacterial imbalances, like severe candidiasis (yeast infection) or bacterial vaginosis, can lead to secondary skin breakdown. Intense itching and inflammation from these conditions provoke scratching, which creates open sores or fissures on the vulvar skin. These secondary lesions are small tears in the tissue barrier prone to further irritation.
Chronic Inflammatory Skin Conditions
Lesions can also be the result of long-term, non-infectious inflammatory diseases that affect the skin’s structure.
Lichen Sclerosus (LS) is a chronic inflammatory disorder that primarily affects the vulva. It causes the skin to become thin, white, and crinkled, often described as having a “cigarette paper” texture. This condition leads to intense itching and can cause permanent architectural changes, such as the shrinking of the labia minora and the burial of the clitoris under scar tissue.
Lichen Planus (LP) is another autoimmune-related condition that frequently presents as bright red, glossy, erosive patches, particularly near the vaginal opening or inside the vagina. LP often involves the mucous membranes, distinguishing it from LS, which rarely affects the vagina. In some forms, LP can also produce characteristic lacy, white streaks on the surface of the lesions, known as Wickham’s striae.
Psoriasis, an immune-mediated condition characterized by rapid skin cell turnover, can also manifest in the genital area. Unlike the classic scaly plaques seen elsewhere on the body, vulvar psoriasis often appears as smooth, red, sharply defined patches due to the moist environment preventing scale formation. These chronic skin conditions are complex, resulting from an ongoing inflammatory response in the body’s immune system.
Physical Irritation and Allergic Reactions
External factors that physically damage or chemically irritate the delicate vulvar tissue are a common cause of temporary lesions, primarily through contact dermatitis.
Irritant Contact Dermatitis
Irritant contact dermatitis occurs when a substance directly damages the skin barrier, causing immediate symptoms like burning, stinging, and rawness. Common culprits include harsh soaps, fragranced hygiene products, or detergent residues on underwear. The resulting lesions are ill-defined patches of redness and inflammation corresponding directly to the area of contact. Physical trauma, such as friction from sexual activity, tight clothing, or excessive scrubbing, can also cause temporary abrasions or small fissures.
Allergic Contact Dermatitis
Allergic contact dermatitis is a delayed, immune-system-driven response to a specific allergen, occurring 48 to 96 hours after exposure. This reaction is characterized by intense itching, redness, and sometimes small blisters or weeping skin. Potential allergens include preservatives in creams, topical medications like neomycin, or components in latex condoms or spermicides. The key difference is that allergic reactions involve sensitization of the immune system, whereas irritant reactions are a direct toxic effect on the skin cells.
When Lesions Indicate Serious Conditions
While most lesions result from infections or inflammation, a small number may signal a more serious underlying issue, such as vulvar neoplasia. Vulvar cancer, though relatively rare, can present as an open sore, a lump, or a wart-like growth that does not heal. Precancerous conditions, such as vulvar intraepithelial neoplasia (VIN), often precede invasive cancer and appear as areas of thickened, discolored skin.
A lesion that persists for more than a month without healing, or one that exhibits rapid growth, requires immediate medical evaluation. Other warning signs include a bump or patch that is black, white, red, or pink, or a lesion accompanied by unexplained bleeding or chronic, unrelenting itching. A diagnostic biopsy, where a small tissue sample is taken, is the definitive method to determine if a lesion is cancerous or precancerous.
Since serious conditions often mimic benign causes, self-diagnosis is inappropriate. Any persistent change in skin texture, color, or the development of an unhealing sore necessitates professional consultation for definitive diagnosis and timely management.