Sores or lesions on the female genitalia may have many causes. Often, the lesions of most concern are those seen with sexually transmitted diseases (STD). Venereal warts, syphilis, genital herpes, chancroid, molluscum contagiosum, and granuloma inguinale are STDs that cause visible and fairly classic appearing lesions.

Precancerous changes of the vulva (vulvar dysplasia) may appear as white red or brown patches on the vulva and are often accompanied by itching. The vulva can also develop skin cancers such as melanoma and squamous cell carcinoma.

Non-sexually transmitted diseases may also produce lesions on the genitalia. In young girls (before puberty), nonspecific vulvovaginitis, atopic dermatitis, and contact dermatitis are common causes of genital lesions. Other common disorders of the skin, such as lichen planus, seborrheic dermatitis, and vitiligo are less common causes. Rarely, a medical illness can cause genital lesions as one of its symptoms ( Crohn's disease.

Because genital lesions (genital sores) often adversely affect a person's self-image, many individuals do not seek proper medical care. These lesions may be caused by a malignancy or a sexually transmitted disease, and in every case should be evaluated by a medical professional.

Itching, painful urination or painful sexual intercourse often accompany genital lesions which can appear anywhere on the vulva (external female genital area).

• benign cysts
• genital warts
• vaginal yeast infection (Candida)
• genital herpes
• gonorrhea
• syphilis
• traumatic injury
• chancroid
• granuloma inguinale
• molluscum contagiosum

Avoid self-treatment before seeing a doctor. It can mask the symptoms and make diagnosis of the cause of the sore more difficult.

A sitz bath may be recommended to relieve itching and crusting. Moist lesions can be dried by using a heat lamp.

If caused by a sexually transmitted disease, the sexual partner should be notified and treated and all sexual activity should be discontinued until the lesion(s) are no longer contagious.

• there are any unexplained genital lesions.
• a sexually transmitted disease is suspected.
• there is any change in the lesion(s).

The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

• type of lesion
  • pustule
  • papule
  • nodule
  • open areas (ulcer)
  • pinpoint red or purple spots (petechiae)
  • larger red or purple splotch (purpura)
  • bruise (ecchymosis)
  • hives or blisters
  • other (be specific)
• other descriptors
  • What color is the lesion?
  • How big is it?
  • Is it painful?
  • Does it itch?
  • Is it scaly?
  • Does the border look distinct (sharp) or blurry?
• time pattern
  • When did you first notice the lesion?
  • How long have you had it?
  • Have you ever had a similar lesion in the past?
• distribution
  • Does the size of the lesion spread?
  • Is there an increasing number of lesions?
  • Is there one lesion or multiple lesions?
• location
  • Exactly where on the genitals is the lesion located?
• other
  • What are the amount and type of sexual activity and sexual habits?
  • What are the hygiene habits?
  • Is there painful urination?
  • Is there painful sexual intercourse?
  • Is there abnormal vaginal drainage?

The physical examination will probably include a pelvic examination.

Diagnostic tests that may be performed include:

• blood tests such as CBC or blood differential
• culture and biopsy (see skin or mucosal biopsy culture) of the lesion(s)

Intervention:
Treatment may include medications that are applied to the skin or that are taken internally. The type of medication varies depending on the cause, but may include corticosteroids, antiviral drugs, antibiotics, or antipruritic substances (for control of itching).

After seeing your health care provider:

If you have been diagnosed with a sexually transmitted disease, you are urged to undergo further testing for all other sexually transmitted diseases and to notify your sexual partner(s) to undergo testing and treatment.

You may want to add a diagnosis related to genital lesions to your personal medical record.