Vaginal Bumps - Conditions, Causes & Treatment

Vaginal bumps may occur for a variety of reasons. When women experience these new bumps, it can cause anxiety and unwanted stress. Some women notice itchy bumps on the outer portions of their genitals days after shaving. Other women are alarmed when they notice a new hard lump on the outer vaginal lip that wasn’t there a day before. Furthermore, there are women who may suddenly feel like the outer portion of their vaginas just aren’t quite right due to unknown bumps, and worry it could be something serious.

This article lists the most common conditions of vaginal bumps and key points to consider.

1) Folliculitis

Look & Feel

• Itchy, occasionally painful, small red bump with or without white pus inside

Cause

After shaving or waxing hair begins to grow back, occasionally creating itchy or painful bumps.^[1] This is caused by ingrown hairs that happen when a thin layer of skin grows over the newly shaved (or waxed) skin, trapping the underlying hair follicle. The bumps themselves are not harmful but may become irritated by friction from undergarments or if picked at by curious hands. This introduces bacteria, resulting in pimples, creating a small pocket of localized infection around the hair follicle. These are unlikely to cause any significant long-term problems and should resolve within a few days as long as they remain clean and unbothered.

Treatment

• Keep the area clean, as they will resolve with time
• Antimicrobial wash or antibiotics administered by a healthcare professional for those bumps that worsen, occur frequently or do not resolve. 
• Prevent with good hygiene and avoid shaving and waxing if possible 

2) Contact Dermatitis

Look & Feel

• Itchy, occasionally painful or burning, more widespread red bumps with surrounding redness
• Usually occurs following the start of a new product like body wash, douches, laundry detergent or other cosmetics applied to the vagina^[2]

Cause

There are two types of contact dermatitis: allergic and irritant. Allergic contact dermatitis (ACD) is due to an immune reaction to something directly touching the skin. Irritant contact dermatitis (ICD) is caused by an irritating substance, causing itchy, painful bumps in anyone it touches, especially in open skin. ACD is much more common in the vaginal region than ICD.^[3]

With exposure to new products in the vaginal regions, the skin may become allergic to small substances in new products. If after trying a new product, medication or clothing you develop itchy red bumps, you should discontinue the product you think caused the reaction. The most common products causing allergy in the vaginal region contain fragrance; thus, avoiding scented products can be helpful.^[2] If you cannot figure out the cause of the rash, you should see a healthcare professional who can help you identify the source or perform a test to determine if you have developed an allergy to common substances.

Treatment

• Detect the cause first!
• If you need relief, a healthcare professional can prescribe a medication

3) Labial Cysts: Bartholin’s cyst

Look & Feel

• A small to large lump at the base of the vaginal lips
• Not inflamed: small, hard, painless, resolves in a few days
• Inflamed: large, red, painful with sitting, walking or sex, feels like it has fluid inside^[4]
• If these cysts become inflamed and infected, an abscess may develop in the area. This will cause significant swelling of the affected vaginal lip, resulting in significant pain.^[4] Anyone with these symptoms should seek medical attention to have the abscess drained

Cause

Cysts are very common; however, they typically come on suddenly without warning, which can be alarming to women. The Bartholin glands are at the very base of the labia or vaginal lumps on either side of the vaginal opening closer to the anus. These secrete mucus to help with vaginal lubrication. When mucus blocks the opening of the gland, a cyst develops.

Treatment

• Asymptomatic small cysts will resolve over time
• Larger, painful, red cysts will need to be drained by a physician and may require a course of antibiotics
• If the cyst ruptures before it can be drained, sitz baths are recommended^[4]

4) Hidradenitis Suppurativa

Look & Feel

• Soft or hard, usually painful masses in the groin that may rupture producing pus, leaving an open sore^[5]

Cause

Hidradenitis suppurativa (HS) is a chronic skin condition affecting the hair follicle and it occurs commonly in the groin, genitals, armpits, around the anus, and around the underside of the buttocks and breasts.^[6] HS most commonly occurs in women and can start as early as puberty. Researchers are still trying to figure out the exact causes of HS; however, inflammation is key to disease development.^[7] The condition can cause significant distress with recurrent painful abscesses, draining wounds, and open sores.

If a patient begins to notice deep, painful masses in any of the areas listed above, they should be evaluated by a professional as HS is a long-term condition that requires long-term treatment. Lifestyle modifications in patients who are cigarette smokers or obese may help with HS management.^[8] The sooner HS is identified, the sooner treatment can begin to decrease the burden of lesions and prevent complications in the long run.

Treatment

• A healthcare professional is best suited to treat HS
• There are many options including antibacterial washes, antibiotics, spironolactone, biologics like FDA approved adalimumab (Humira®) and surgical removal of the affect areas^[7]
• A discussion with a professional will help to determine the best individualized course of treatment

5) Molluscum Contagiosum

Look & Feel

• Multiple, painless, small flesh-colored domes with a dimple on the top and may feel waxy.^[9]

Cause

While this is a very common condition in young children and may occur on any part of their bodies, Molluscum contagiosum (MC) is considered a sexually transmitted infection (STI) in adults.^[9] MC is a virus that can only be contracted through direct contact with infected skin or other infected objects that contact the genitals. MC does not usually cause significant problems for people with normal immune systems. If a person is immunocompromised with HIV or systemic medications, the virus may spread rapidly and become very difficult to control and treat. If a person constantly develops MC infections, it may be a sign they are immunodeficient.^[9] The bumps remain contagious until completely treated, which can take months. Most bumps will last 2 months, but if the virus continues to spread through scratching and transfer onto clothing, towels, other objects, the virus may last 8 – 10 months.^[10]

Treatment

• Potassium hydroxide (KOH) solution daily until bumps disappear
• Freezing by a professional with liquid nitrogen every 1 – 4 weeks until bumps disappear^[11] Cantharidin, trichloroacetic acid, retinoids and imiquimod 5% cream are additional therapies a healthcare professional can recommend^[12]

6) HPV Bumps: Genital warts

Look & Feel

• Single or multiple, painless, skin-colored bumps
• May be small or large, smooth or rough, in groups or scattered

Cause

Human papillomavirus (HPV) is an STI, also transmitted with direct contact. These bumps are typically painless and do not itch. Once these bumps are identifiedid a healthcare professional can ensure that they are truly genital warts and direct the proper therapy. those with genital warts should refrain from having sex, and use condoms even when the bumps cannot be seen,  as the virus is transferred by skin to skin contact.^[13] Any sexual partners should also be evaluated.

It is important to note that HPV has many different strains—some strains cause genital warts (6, 11), others cause cervical or anal cancer (16, 18, 33, 35).^[13] The strains that cause cervical or anal cancer will not cause bumps on the vagina. Other strains cause the common wart, among others. Pap smears are used to detect the HPV strains that cause cervical cancer. All women from 21 to 65 years should undergo Pap smears regardless of symptoms, because cervical cancer may not cause symptoms initially.

Treatment

There are a variety of treatments for genital warts including imiquimod 3.75%, liquid nitrogen, and photodynamic therapy among others.^[14] There is also a vaccine that can prevent many strains of HPV including the strains causing genital warts, cervical and anal cancer.^[13]

7) Herpes

Look & Feel

• Multiple painful, red open sores without pus and/or groups of small blisters on a red background

Cause

Herpes is another STI virus, with two strains: HSV-1 and HSV-2.^[15] HSV-1 is usually associated with mouth ulcers or cold sores, while HSV-2 is usually associated with genital herpes. However, it is possible to have oral herpes from HSV-2 and genital herpes from HSV-1. Regardless, genital herpes has a common presentation. The initial outbreak is often the most painful with the most number and most symptomatic active lesions. Once the lesions have disappeared the virus will remain inside the body. Because the virus is seldom cleared, subsequent outbreaks may occur. The outbreaks are usually less severe than the original and will often present with fewer sores. Some people may not know they have herpes or even have an outbreak. Using condoms and/or getting tested even when neither partner thinks that they have an infection is important.

Treatment

• A doctor will prescribe acyclovir daily or valacyclovir daily for several weeks
• While antivirals will resolve the visible signs of herpes, the virus remains inside the body and may cause additional outbreaks
• Acyclovir can be used to prevent an outbreak if started at the onset of symptoms^[15]

An 8^th Condition You Should Always Keep in Mind: Cancer

Most people joke that when you read information online, everyone thinks that they have cancer. It is very unlikely that a vaginal bump is cancer, but it is something to keep in mind and not a joking matter. There are a variety of different cancer types that can present in the genital region. If the bump appears gradually, does not go away quickly, and/or enlarges or changes over time, a healthcare professional can evaluate the bump for an accurate diagnosis.