Vulval lesions

What are vulval lesions?

A vulval lesion is any lump, patch, sore, or change in the skin or tissue of the vulva, the area covering the external female genitals. What counts as normal varies enormously between individuals, so a change is best judged against what's usual for you rather than against anyone else.

Most vulval lesions are harmless. Even so, since a small number turn out to need treatment or monitoring, it's always worth getting anything new or changing looked at by your GP or a health care professional.

What are the common causes of vulval lesions?

Everyday, harmless causes are by far the most frequent:

• Skin cysts, small fatty lumps, or skin tags
• Moles, which tend to look larger and less regular here than they do elsewhere on your body, simply because of how vulval skin behaves
• Small yellowish bumps called Fordyce spots, or tiny red dots known as cherry angiomas
• Genital warts or molluscum contagiosum, both caused by viruses
• A Bartholin's cyst, a swelling that forms when a gland near the vaginal opening becomes blocked.

Ongoing skin conditions are also common, and tend to bring itching, soreness, or patches of colour change rather than a single obvious lump:

• two related inflammatory skin conditions, lichen sclerosus and lichen planus, plus eczema more generally
• lichen simplex, where the skin becomes thick and constantly itchy after a long spell of scratching.

Less often, a lesion is a precancerous change (vulval intraepithelial neoplasia, or VIN) or vulval cancer itself.

Are there different types of vulval lesions?

It helps to think about vulval lesions in three broad groups:

• Straightforward, one-off lumps: Such as cysts, skin tags, warts, or ordinary moles, which are common, harmless, and often need no treatment at all
• Chronic skin conditions: Most notably lichen sclerosus and its relative lichen planus, which can flare and settle with treatment, but need long-term follow-up, since a small proportion, somewhere around 3 to 6 in 100 people with lichen sclerosus, will eventually develop a related cancer
• Precancerous or cancerous change: Which is rare but is exactly why persistent, unusual, or asymmetrical lesions need proper assessment rather than being left.

How are vulval lesions diagnosed?

Your GP will usually ask what the lesion feels like (itchy, sore, or painful), whether it's there all the time or comes and goes, what it looks like, and whether you've tried treating it yourself already.

They'll then want to examine the area, checking both the outer and inner parts of the vulva, whether there's one change or several, and whether the nearby glands in your groin feel swollen.

When booking, you're entitled to request a woman doctor, and you're welcome to have someone with you in the room, whether that's a partner, a relative, or another staff member as a chaperone. You stay in control throughout and can ask the examination to stop at any point.

If anything about the lesion is uncertain, uneven, or doesn't fit a straightforward pattern, a small sample of tissue (a biopsy) is usually the only reliable way to know exactly what it is, and your GP will refer you on to a relevant specialist for that.

How are vulval lesions treated?

Plenty of causes need no treatment beyond reassurance, particularly small cysts, tags, or moles that aren't bothering you. General vulval skin care helps across the board: washing gently with plain water, or a plain emollient as a soap substitute, avoiding perfumed products.

Ongoing conditions such as eczema, lichen planus, and lichen sclerosus usually respond well to a steroid ointment applied to the skin, often started at a stronger strength and gradually tapered down over several weeks, alongside working to break any cycle of scratching that's kept things going.

A Bartholin's cyst that's grown uncomfortable can be drained, usually as a day case in hospital. Where a precancerous change or cancer is found, you'll be referred to a specialist gynaecology or vulval clinic, who can discuss the right next steps with you directly.

When should you see a doctor?

See your GP about any vulval lump, patch, or change you're unsure of, particularly if it's new, persisting, or altering how your skin looks or feels.

Please don't let embarrassment hold you back: this is one of the most ordinary conversations a GP has, and getting things checked early makes treatment far more straightforward if it's ever needed.

Ask for an urgent referral, or expect your GP to arrange one, if you have:

• an uneven-looking lesion with no obvious explanation
• an unexplained lump, open sore, or bleeding
• an unexplained swelling near the entrance to your vagina
• a patch of darker pigmentation
• an existing mole that has changed shape or colour.

If you've already been diagnosed with lichen sclerosus, or with lichen planus, mention any new change to your GP promptly rather than waiting for your next routine review.