The vulva is the outer part of a woman’s genitals. Vulvar ulcers are sores that appear in this area. Vulvar ulcers can be extremely painful and, in some cases, they may not hurt at all.

Most of the time these lesions are caused by sexually transmitted infections (STIs) but many other issues can trigger an ulcer. There are several effective treatment options for these sores.

Read on to learn more about what causes vulvar ulcers and how to treat them.

Vulvar ulcers might start out looking like bumps or a rash. Or, the sores might appear as breaks in your skin that expose tissue.

Symptoms of vulvar ulcers vary, but may include:

  • pain or discomfort
  • itchiness
  • leaky fluid or discharge
  • painful or difficult urination
  • enlarged lymph nodes
  • fever

Sometimes, vulvar ulcers don’t cause any symptoms.

Generally, vulvar ulcers are classified as being sexually acquired or nonsexually acquired.

A sexually acquired vulvar ulcer means the lesion is the result of sexual contact. This is the most common type of genital ulcer.

Nonsexually acquired ulcers are also called acute genital ulcers. These are more common in young women who aren’t sexually active.

There are many possible reasons vulvar ulcers develop, including:

1. STIs

The most common cause of genital ulcers in the United States is the herpes simplex virus (HSV), followed by syphilis. Other STIs can lead to ulcers, including:

Additionally, some women with HIV may develop ulcers on their genitals.

STIs are more common that you might think. According to the American Sexual Health Association, 1 in 2 people who are sexually active will contract an STI by age 25.

2. Fungal infections

Vulvovaginal candidiasis, also known as vaginal yeast infection, is the most common fungal infection that causes vulvar ulcers or erosions. Other symptoms of yeast infections include:

  • burning during sex and urination
  • itching
  • increased vaginal discharge

3. Viral infections

Certain viruses can cause vulvar ulcers to form:

  • Epstein-Barr virus
  • cytomegalovirus
  • varicella zoster, the virus that causes chickenpox and shingles

4. Bacterial infections

Infections caused by bacteria, such as Group A Streptococcus and mycoplasma, can trigger sores on the vulva. Bacterial infections are usually treated with antibiotics.

5. Inflammatory diseases

Several types of inflammatory and autoimmune diseases can cause lesions to form around the vulva. Depending on how severe these are, they may appear like ulcerations. Some of these include:

6. Trauma

Chronic rubbing or scratching of the vulva can lead to skin irritation and ulcers.

7. Other illnesses

Sometimes, common conditions like tonsillitis, upper respiratory infections, or a virus that causes diarrhea can cause genital ulcers, especially in adolescent girls.

8. Drug reactions

Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonamides, and certain antibiotics can cause a reaction that triggers ulcers.

9. Cancer

Vulvar cancer can cause ulcerlike lesions around the vagina. This type of cancer is more common in older women.

10. Skin reactions

Sometimes, a bad reaction to skin care products can cause a genital ulcer. You might want to switch to soaps and lotions for sensitive skin if this happens.

Worldwide, about 20 million people develop some type of genital ulcer condition each year.

HSV types 1 and 2 are the most common causes of genital ulcers in the United States. 1 in 5 women and 1 in 9 men ages 14 to 49 has genital HSV type 2 infection.

Your doctor will probably perform a physical exam and explore your health history to determine what’s causing your vulvar ulcers. You might be asked about your sex life, number of sexual partners, and what medications you take.

Additionally, your physician will need to look at the ulcer or ulcers to get a better idea as to what could be causing them.

Your doctor may recommend one or more of the following tests:

You may also need a biopsy. A biopsy is a procedure that involves removing a sample of the ulcer and sending it to a lab for further examination.

Your treatment approach will depend on what’s causing your ulcers. Some vulvar ulcers may go away on their own, but others will require prompt therapy so they don’t lead to infection.

Your doctor might recommend several types of therapies to treat your condition.

STIs are typically treated with antibiotic and antiviral medicines, given as either a pill or a shot.

Vulvar ulcers that aren’t caused by infections may be treated with:

  • corticosteroids
  • antihistamines
  • immunomodulatory drugs, such as methotrexate

Your healthcare provider might show you how to effectively clean your ulcer until it heals. You might also need special dressings to cover and protect the area.

Sometimes, home remedies may be used to relieve the pain and discomfort of vulvar ulcers. Popular methods include:

  • Epsom salt baths
  • oral pain relievers, such as acetaminophen (Tylenol)
  • cool compresses to the affected area
  • topical anesthetics, such as lidocaine
  • barrier ointments, such as petroleum and zinc oxide
  • avoiding irritants, such as harsh soaps, douches, or tight-fitting clothing

If vulvar ulcers are left untreated, they may lead to complications.

In some cases, scarring, adhesions, infection, and inflammation can occur in or around your genitals. Additionally, untreated ulcers can lead to continued pain and emotional stress.

If you have an untreated STI, you’re at risk of contracting another one. You can also spread the infection to others. Some STIs can cause serious issues. For example, untreated syphilis can lead to nervous system and heart problems. And if you become pregnant, an STI can affect the fetus.

Many STIs can be cured or managed with proper treatment. Other causes of ulcers may be helped with the right therapies.

You might be able to prevent or lower your risk of a vulvar ulcer by practicing safe sex and getting tested for STIs regularly.

If your vulvar ulcer is caused by another medical condition, such as an inflammatory or autoimmune disease, you may be referred to a specialist who can help treat your condition.

Although vulvar ulcers might elicit embarrassment, you should see your doctor right away if you develop them. You don’t have to live with the pain, discomfort, and distress that these lesions commonly cause.