Recognizing common vulvar lesions
Vulvar lesions are cutaneous lumps, nodules, papules, vesicles, or ulcers that result from benign or malignant tumors, dystrophies, dermatoses, or infection. They can appear anywhere on the vulva and may go undetected until a gynecologic examination. Usually, however, the patient notices the lesions because of associated symptoms, such as pruritus, dysuria, or dyspareunia.
Various disorders can cause vulvar lesions. For example, sexually transmitted diseases account for most vulvar lesions in premenopausal women, whereas vulvar tumors and cysts account for most lesions in women ages 50 to 70. The illustrations below will help you recognize some of the most common lesions.
|Primary genital herpes
Produces multiple ulcerated lesions surrounded by red halos.
Produces chancres that appear as ulcerated lesions with raised borders.
|Squamous cell carcinoma
Can produce a large, granulomatous-appearing ulcer.
|Basal cell carcinoma
Can produce an ulcerated lesion with raised, poorly rolled edges.
|Epidermal inclusion cysts
Produce a round lump that usually appears on the labia majora.
|Bartholin’s duct cysts
Produce a tense, nontender, palpable lump that usually appears on the labia minora.
- Genital warts. This sexually transmitted condition is characterized by painless warts on the vulva, vagina, and cervix. The warts start as tiny red or pink swellings that grow and become pedunculated. Multiple swellings with a cauliflower-like appearance are common. Other findings include pruritus, erythema, burning or paresthesia in the vaginal introitus, and a profuse mucopurulent vaginal discharge.
- Gonorrhea. Although most women with gonorrhea are asymptomatic, some develop vulvar lesions, which are usually confined to Bartholin’s glands and may be accompanied by pruritus, a burning sensation, pain, and a green-yellow vaginal discharge. Other findings include dysuria and urinary incontinence; vaginal redness, swelling, bleeding, and engorgement; and severe pelvic and lower abdominal pain.
- Granuloma inguinale. This rare, chronic venereal infection begins with a single painless macule or papule on the vulva that ulcerates into a raised, beefy-red lesion with a granulated, friable border. Later, other painless and possibly foul-smelling lesions may erupt on the labia, vagina, or cervix. Eventually, they become infected and painful and may be accompanied by enlarged and tender regional lymph nodes, fever, weight loss, and malaise.
- Herpes simplex (genital). In this disorder, fluid-filled vesicles appear on the cervix and, possibly, on the vulva, labia, perianal skin, vagina, or mouth. The vesicles, initially painless, may rupture and develop into extensive shallow, painful ulcers, with redness, marked edema, and tender inguinal lymph nodes. Other findings include fever, malaise, and dysuria.
- Herpes zoster. This viral infection may produce vulvar lesions, although other areas are more commonly affected. Small, red nodular lesions erupt on painful erythematous areas. The lesions quickly evolve into vesicles or pustules, which dry and form scabs about 10 days later. Other findings include fever, malaise, paresthesia or hyperesthesia, and pain.
- Lymphogranuloma venereum. Most patients with this bacterial infection initially exhibit a single painless papule or ulcer on the posterior vulva that heals in a few days. Painful, swollen lymph nodes, usually unilateral, develop 2 to 6 weeks later. Other findings include fever, chills, headache, anorexia, myalgia, arthralgia, weight loss, and perineal edema.
- Malignant melanoma. This type of skin cancer may cause irregular, pigmented vulvar or clitoral lesions that enlarge rapidly and may ulcerate and bleed.
- Molluscum contagiosum. This viral infection produces raised, umbilicated, pearly or flesh-colored vulvar papules that are 1 to 2 mm in diameter and have a white core. Pruritic lesions may also appear on the face, eyelids, breasts, and inner thighs.
- Pediculosis pubis. This parasitic infection produces erythematous vulvar papules with pruritus and skin irritation. Adult pubic lice and nits are visible on pubic hair with magnification.
- Squamous cell carcinoma. Invasive carcinoma occurs primarily in postmenopausal women and may produce a painful, pruritic vulvar tumor. As the tumor enlarges, it may encroach on the vagina, anus, and urethra, causing bleeding, discharge, or dysuria. Carcinoma in situ is most common in premenopausal women and produces a vulvar lesion that may be white or red, raised, well defined, moist, crusted, and isolated.
- Squamous cell hyperplasia. Formerly known as hyperplastic dystrophy, this disorder produces vulvar lesions that may be well delineated or poorly defined; localized or extensive; and red, brown, white, or red and white. However, its cardinal symptom is intense pruritus, possibly with vulvar pain, intense burning, and dyspareunia. In lichen sclerosis, a type of vulvar dystrophy, vulvar skin has a parchmentlike appearance. Fissures may develop between the clitoris and urethra or other vulvar areas.
- Syphilis. In this sexually transmitted disease, chancres may appear on the vulva, vagina, or cervix 10 to 90 days after initial contact. They usually start as painless papules and then erode to form indurated ulcers with raised edges and clear bases. Condylomata lata develop after these ulcers clear up. These highly contagious secondary vulvar lesions are raised, gray, flat topped, and commonly ulcerated. Other findings include a maculopapular, pustular, or nodular rash; headache; malaise; anorexia; weight loss; fever; nausea and vomiting; generalized lymphadenopathy; and sore throat.
- Viral diseases (systemic). Varicella, measles, and other systemic viral diseases may produce vulvar lesions.