Vaginal Ulcers: Symptoms, Causes, and Treatment

Vaginal ulcers are sores or wounds that can develop on the vagina or surrounding genital areas. These ulcers often result from infections, especially sexually transmitted infections (STIs), but can also arise from other medical conditions or trauma1 . Because vaginal ulcers can cause discomfort and lead to complications if untreated, understanding their symptoms, causes, and treatment options is essential for timely care2 .

Vaginal Ulcer Symptoms

Vaginal ulcers present as visible sores or lesions on the vulva, vagina, or perianal area3 . Their appearance varies widely depending on the cause, ranging from small grouped vesicles (fluid-filled blisters) or papules that may look like a rash before ulcerating, to larger necrotic (dead tissue) lesions4 5. Some ulcers are painful, such as those caused by herpes simplex virus (HSV), while others, like syphilis ulcers, are often painless6 5.

Common symptoms accompanying vaginal ulcers include:

Pain or burning sensation, especially during urination or sexual intercourse5 7
Abnormal vaginal discharge, which may be malodorous or unusual in color or consistency5
Itching or irritation around the genital area8 9
Dysuria (painful or difficult urination) 5
Fever or systemic symptoms in some cases6

In early stages, ulcers may appear as small bumps or rashes with swollen lymph nodes in the groin area. As ulcers worsen, they may ooze pus or fluid and develop crusted surfaces, particularly in herpetic infections4 1.

Genital ulcers are small wounds that can form on the vagina, penis, or anus. The most common cause is sexually transmitted infections1 .

Causes of Vaginal Ulcers

Vaginal ulcers have diverse causes, broadly categorized into sexually transmitted infections, other infections, medical conditions, and trauma. Accurate diagnosis depends on clinical examination and laboratory testing to identify the underlying cause6 5.

Sexually transmitted infections are the leading cause of vaginal ulcers worldwide. The most common STIs causing these ulcers include:

Herpes simplex virus (HSV) types 1 and 2: HSV is the most frequent cause of genital ulcers in the United States. Herpetic ulcers typically begin as painful vesicles that rupture and form shallow, crusted lesions. HSV lesions may occur inside the vagina, on the labia, or around the anus3 52.
Syphilis (Treponema pallidum): Primary syphilis presents as a single, painless, indurated (firm) ulcer called a chancre with a clean base. Syphilis ulcers are often accompanied by swollen lymph nodes11 52.
Chancroid (Haemophilus ducreyi): This bacterial infection causes painful, nonindurated ulcers with a serpiginous (wavy) border and a friable base covered with necrotic exudate11 .
Lymphogranuloma venereum (Chlamydia trachomatis): Characterized by small, shallow, painless genital or rectal papules that may ulcerate11 10.
Other STIs: Granuloma inguinale and donovanosis are less common but can cause genital ulcers11 10.

STI-related vaginal ulcers often present with additional symptoms such as malodorous discharge, dyspareunia (painful intercourse), and dysuria5 .

Non-sexually transmitted infections can also cause vaginal ulcers, including:

Bacterial infections: Group B Streptococcus and Group A Streptococcus have been reported to cause vaginal or cervical ulcers, sometimes associated with bacterial vaginosis12 13.
Fungal infections: Severe or untreated vulvovaginal candidiasis (yeast infection) may lead to ulceration, accompanied by itching, burning, and thick white discharge14 158.
Viral infections: Besides HSV, viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), influenza A, and varicella-zoster virus can cause genital ulcers16 17.
Systemic infections: Rarely, infections like Mycoplasma pneumoniae, Salmonella bacteremia, and Lyme disease have been linked to genital ulcers18 1920.

Several non-infectious medical conditions can cause vaginal ulcers:

Autoimmune and inflammatory diseases: Behçet’s disease is a systemic inflammatory disorder that can cause painful genital ulcers, sometimes localized in the vagina and potentially painless, making diagnosis challenging21 2223.
Lipschütz ulcers: Also known as ulcus vulvae acutum, these are rare, acute, non-sexually transmitted vulvar ulcers that typically affect young, sexually inactive females. They often follow flu-like or mononucleosis-like symptoms and present as painful necrotic ulcers with a gray-black exudate and erythematous border. Lipschütz ulcers are self-limiting and resolve within two to four weeks16 25.
Inflammatory dermatoses: Conditions like psoriasis and erosive lichen planus can cause ulcerations in the genital area21 2217.
Malignancies: Rarely, vulvar or vaginal cancers may present with ulcer-like lesions26 17.

Physical injury or irritation can lead to ulcer formation. Causes include:

Sexual trauma or injury21 17
Chemical burns or reactions to topical products27 17
Chronic rubbing or scratching due to itching or irritation17

Proper identification of trauma-related ulcers is important to avoid unnecessary treatments.

Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Herpes simplex virus is the most common cause of genital ulcers in the United States28 .

When to See a Doctor

Any unusual genital symptoms, such as sores, ulcers, or persistent pain, warrant prompt evaluation by a healthcare professional5 9. Early consultation is critical because:

Vaginal ulcers have a broad differential diagnosis, including STIs, non-sexually transmitted infections, autoimmune diseases, and trauma6 1121.
Untreated ulcers can lead to complications, including secondary infections and increased risk of transmission of infectious agents6 5.
Diagnosis often requires a detailed medical history, physical examination, and laboratory testing such as swabs for PCR, cultures, and serology to identify infectious agents or exclude malignancy6 115.

Seek medical care if you experience any of the following:

Painful or persistent genital ulcers1
Abnormal vaginal discharge or bleeding5
Fever or systemic symptoms accompanying genital sores6
Difficulty or pain during urination or sexual activity5
History of unprotected sexual contact or multiple partners2

Vaginal Ulcer Treatments

Treatment of vaginal ulcers depends on the underlying cause. Accurate diagnosis through clinical evaluation and laboratory testing guides appropriate therapy6 115.

Key treatment approaches include:

Antimicrobial therapy:
Antibiotics for bacterial infections such as syphilis, chancroid, or group B streptococcus11 125.
Antiviral medications like acyclovir or valacyclovir for herpes simplex virus infections, which reduce symptom duration and transmission risk11 510.
Antifungal agents, mainly azoles, for vulvovaginal candidiasis14 159.
Symptomatic management:
Pain control using systemic analgesics such as NSAIDs or acetaminophen9 29.
Topical anesthetics like lidocaine gel can provide local pain relief30 29.
Gentle wound care and hygiene to promote healing and prevent secondary infections9 29.
Warm sitz baths to soothe vulvar discomfort9 29.
Avoidance of irritants: In non-infectious cases such as irritant contact dermatitis, avoiding the offending agents is essential27 .
Supportive care for rare conditions: Lipschütz ulcers are self-limiting and primarily require pain management and supportive care16 25.
Abstinence from sexual activity: Patients with active genital ulcers should avoid sexual contact to reduce transmission risk10 .

Early diagnosis and treatment of vaginal ulcers are vital to prevent complications and reduce the spread of infections. Laboratory tests such as PCR and serology help identify the cause, enabling targeted therapy11 56.

Preventing Vaginal Ulcers

Preventing vaginal ulcers focuses on reducing exposure to infectious agents and maintaining vaginal health. Effective strategies include:

Practicing safe sex, including consistent use of barrier methods like condoms5 31.
Regular screening and early treatment of sexually transmitted infections5 31.
Maintaining good vaginal hygiene by washing with mild soap and water and avoiding harsh chemicals or scented products9 27.
Wearing breathable cotton underwear and avoiding tight-fitting clothing to reduce irritation9 27.
Avoiding trauma or excessive rubbing of the genital area17 .

These measures help preserve the natural vaginal flora and mucosal integrity, lowering the risk of ulcer formation14 927.

Possible Complications

Complications from vaginal ulcers depend on the cause and how quickly treatment is initiated. Potential issues include:

Secondary bacterial infections that prolong healing and increase discomfort6 5.
Infertility and adverse pregnancy outcomes from untreated STIs like syphilis5 31.
Chronic pain and scarring in severe or recurrent cases17 .
Increased risk of HIV transmission due to genital ulcer disease raising viral shedding10 .
Rarely, progression to malignancy in untreated or chronic ulcerations5 31.

Early medical evaluation and appropriate treatment are essential to prevent these complications and improve health outcomes6 115.

Summary and Key Points

Vaginal ulcers are sores that can appear on the vagina, vulva, or surrounding areas, often caused by sexually transmitted infections but also by other infections, autoimmune diseases, or trauma1 2.
Symptoms vary but commonly include pain, burning, abnormal discharge, and sometimes systemic signs like fever5 7.
The most common infectious causes are herpes simplex virus and syphilis, with other bacterial, fungal, and viral infections also contributing6 115.
Non-infectious causes include autoimmune conditions like Behçet’s disease and rare entities such as Lipschütz ulcers21 2216.
Diagnosis requires thorough clinical evaluation and laboratory testing to guide targeted treatment6 115.
Treatment involves antimicrobials for infections, symptomatic care, and avoidance of irritants9 1129.
Prevention centers on safe sexual practices, hygiene, and avoiding trauma9 275.
Untreated vaginal ulcers can lead to serious complications, including secondary infections, infertility, and increased HIV risk6 531.

Key Takeaways

Vaginal ulcers most commonly result from sexually transmitted infections but have diverse causes6 115.
Early diagnosis and treatment reduce complications and transmission risk6 5.
Safe sex practices and good hygiene are critical preventive measures9 275.
Painful ulcers often indicate herpes, while painless ulcers suggest syphilis or other causes6 5.
Non-infectious ulcers like Lipschütz ulcers require supportive care and usually resolve spontaneously16 25.