Don’t worry, I won’t get graphic.
Descriptive yes, but not overly striking images of lesions will be found here. I will leave it to Google Images to show you the absolute worst case of any disease, because that is what Google is good for: Making sure that you know that you could drop dead at any given moment. #ThanksGoogle
Back to the lesson at hand…
Imperfection needs inspection so I’m’ma let ’em understand.
From a Gyn-NE’s perspective,
Every lesion has a reason, look for classic signs and symptoms.
Sidebar- I actually can appreciate the fact that Snoop Dogg included contraceptive use in Nuthin’ But A “G” Thang back in the day. These rappers these days could take a lesson in that, cause ain’t no lovin’ good enough to get burnt while… you know the rest.
Ending that LONG parenthetic pause, again, sometimes even I don’t know what a lesion is until I swab it or take a biopsy. There are some rules of the road that can narrow suspicion though. I am going to try break the top 10 down in systematic way so as to help you know how concerned you need to be, or how far out you can chill.
Ask yourself the following questions. Your answers will narrow down the diagnosis.
- Does it hurt?
- How long has it been there, and how long did it take to go away if it went away?
- Has it changed in appearance or color or multiplied?
- Are you sexually active, especially unprotected, and especially with a new partner? (Though things can be transmitted even if you have had the same partner for a long time and use condoms consistently.)
- Is your groin sore/are lymph nodes swollen and tender right in that crease between your legs and your pubic region?
I tried to color code a key for ease in matching symptoms with the alleged diagnosis, but the complexity was blocking my greatness and giving me a headache. Text colors- back to black for you.
Here are some common causes of growth on the vagina/vulva as well as their various characteristics.
Get out your handheld mirror and let’s get started.
1. Folliculitis or hidradenitis- aka an ingrown hair or infected sweat gland
These are ingrown hairs and infected hair follicles and sweat glands, classically known as boils. If you have course curly hair, shaving can increase your risk for ingrown hairs. You may need to use an electric hair clipper instead so as to not cut the hair beneath the skin. This doesn’t leave you skin super smooth, but you have to choose which is worst: Stubble or numerous puss filled painful bumps. Being overweight can also increase the risk of developing infected sweat glands that will classically grow and cause pain, prior to rupture. Weight loss can decrease their frequency and severity. These can be treated with warm compresses twice daily and baths. If that doesn’t help, you may need to have them drained by a doctor. Put the needle away, lady. Occasionally I have women use topical or oral antibiotics as well. Let your doctor make that call.
2. Skin tag
Skin tags are fleshy, not painful, small growths that show up usually slowly, and then just stay. They don’t usually enlarge over time, but a person can develop multiple, much like a person can develop multiple moles over time. Skin tags aren’t dangerous but can sometimes be annoying if they get caught in clothing or jewelry. There is nothing wrong with showing them to your doctor to make sure that’s what they are. Biopsies are last resort for any lesion to confirm the diagnosis. Often that is not needed for a skin tag.
3. Genital warts
Caused by the HPV virus and often sexually transmitted, painless, genital warts also grow slowly but multiply more rapidly than skin tags. They may even grow on top of each other like broccoli or cauliflower. They are also flesh colored but often slightly harder than skin tags. They are not always easy to distinguish from molluscum (next possibililty) even by a trained eye. This is where biopsies come back into the conversation. The skin can be cleaned, numbed and a scalpel can be used to remove a sample. Pathologists can then look at the tissue and tell me what it is. Genital warts are usually pretty easy to treat with medication or manual removal. The pathologists also help to make sure no advanced precancer or cancer is present in the lesion. #ilovemypathologists
4. Molluscum contagiosum
This is another virus that is transmitted by skin contact and can lead to painless fleshy growths. Biopsies are often necessary to confirm this diagnosis, and these can also be removed in the office by a gynecologist or dermatologists. In the genital region, these often are sexually transmitted, but they can be present on any part of the body and passed from any skin to skin contact. Hand washing is extremely important with any contact with the genital region. SIDEBAR: LADIES, PLEASE stop showing me your new lumps or bumps by touching your genital region, then without any involvement of soap and water, touching your hair, your phone, my doorknobs in the office etc. Just because you are comfortable with your body, doesn’t mean you need to share that love all around the office. Wash your hands or just tell me where your area of concern is and let me find it without you bare-finger touching the area and carrying on like it’s a regular day. I wash my hands like I have OCD and wear gloves for a reason. I don’t want my pen that you want to borrow to be an unsuspecting vessel for your personal places.
5. A Mole
A pigmented mole that has any irregularity or is changing in any way should be evaluated for possible melanoma or any other abnormality. If you have had that same pigmented or non-pigmented mole forever and it never has changed, leave that bad boy alone. It isn’t bothering anybody. If it really bothers you, it can be removed, but the likelihood of danger in a painless stable lesion is slim to none.
Herpes hurts. An initial outbreak is usually the cause of significant pain and swollen, tender inguinal lymph nodes for days to weeks. Recurrences are usually not as significant. They can cause more mild tenderness, small lesions, itching or tingling. This is where that mirror can come into play. When I diagnose a person with herpes who is having an outbreak but didn’t know she even had the disease, it is usually someone who thinks she just has a yeast infection or “scratched” herself, but never looked down there to see if there was any localized skin break. If you see a small cluster of clear vesicles, or even a single tender pimple like structure or open sore, it is probably worth seeing your gynecologist right away to check it out and run some tests.
7. Yeast or Candidiasis:
If you are itching and nothing seems to help, the cause may be yeast. Itching is the hallmark. Abnormal smell is an uncommon symptom. Some can develop small bumps from yeast. This is not a common symptom, but I have definitely seen it. I don’t fault a woman for trying an over the counter yeast medication prior to coming in to see her gynecologist. I am not a huge fan of the 1-day over-the-counter meds. I like a 3-day or longer treatment for the best possible chance of treatment.
Though it sounds like a diagnosis of yesteryear, it is not. Syphilis is still an STD that is alive and well. If you have a painless ulcerated lesion that is not easily explained or swollen lymph nodes without a good cause (what is a good cause for swollen lymph nodes?), call your Gyne and come in for testing. This lesion could last for 3-6 weeks without treatment but then resolve. That, unfortunately, is the 1st of the 3 stages of syphilis. The good news is that this disease is curable with antibiotics, but the diagnosis needs to be made first.
9. A Tick Bite
You would be surprised how easy it is to not realize that you have a tick that is stick and burrowed into your skin. This can cause a sore lesion with a black scab-like thing in the middle. That “thing” will have legs at first, but then the legs will burrow under the skin along with the head. The problem with pulling ticks out on your own is that the head can break off and stay in your skin. That needs to be removed to avoid infection, and any other tick-bite repercussions need to be monitored for. You won’t find me camping again after it happened to me in elementary school that ONE GOOD TIME. One got me on my torso by my bottom rib. Talk about wanting to jump up out of your OWN SKIN. Ughhhh (as I shake in my seat almost 3 decades later).
10. Bartholin Gland cyst or abscess
This is a painful enlargement of the labia on one side or the other caused by either a blocked or both blocked and infected Bartholin gland. With a mirror, one side of the labia will appear significantly swollen and asymmetric. This is not just a pimple or small lesion. These can sometimes resolve on their own with warm compresses and warm baths. Sometimes, they need to be drained by a doctor and antibiotics may be necessary. Again, PUT THE NEEDLE DOWN. In extreme and recurrent cases, a small catheter needs to be placed inside of it to allow complete drainage or the entire gland needs to be removed. These extremes are infrequent, so starting with tolerable heat twice daily down below is a great first step to try to stop it in it’s tracks.
If you were looking for more details, feel free to take your curiosity back to Google. Enter Images at your own risk. Better for you to stick with this general guideline and call your doctor for an ASAP appointment if you need more answers to your specific issue.
Don’t worry, you can’t gross me out. I’m a GYNECOLOGIST.
Dr. Wendy Goodall McDonald is a board certified OBGYN. She began practicing medicine in 2007 and now uses her extensive knowledge and growing following to increase health awareness in a fun and viral way. She is the founder of The Gyneco-blogic and an author of numerous books for adult and childhood health education and social growth. For more, check me, I mean her out at dreverywoman.com