Bumps on the vaginal area and vulva: what they can be

Finding a bump in the genital area is one of the commonest reasons people start searching late at night rather than asking anyone. The first thing worth saying is that almost everything described as a vaginal bump is not inside the vagina at all. It sits on the vulva, the external genital skin, and that distinction changes what the finding can be. Vulval skin behaves like skin elsewhere on the body: it grows hair, it has oil glands, it blocks ducts, it catches infections, and it develops the same ordinary lumps that appear on a shoulder or a thigh.

This article works through the findings that account for most vulval bumps: normal anatomy mistaken for disease, ingrown hairs and inflamed follicles, cysts including Bartholin's cysts and skin cysts, skin tags, genital warts, herpes lesions and the skin condition lichen sclerosus. For each it describes what the finding usually looks like, how it feels under a finger and whether it is painful. It also explains why appearance alone does not settle a diagnosis, and it names separately the findings that should not be watched at home, because some lumps need assessment the same day.

Most bumps people call vaginal are on the vulva

The vulva is everything visible from the outside: the mons pubis, the outer lips or labia majora which carry pubic hair, the inner lips or labia minora, the clitoral hood, the vestibule immediately around the vaginal opening, and the perineum. The vagina is the muscular canal inside, lined by mucosa rather than by skin. It carries no hair follicles and no sebaceous glands, which means that a lump arising from a hair or from an oil gland cannot be a vaginal lump in the literal sense, however it is described.

• Mons pubis and labia majora: hair bearing skin with follicles and oil glands, where ingrown hairs, inflamed follicles and skin cysts arise.
• Labia minora and clitoral hood: thinner skin with few or no hair follicles, where small normal papules such as Fordyce spots and vestibular papillae are common. Skin tags belong to the friction areas further out, in the groin and on the outer lips.
• Vestibule, the area immediately around the vaginal opening: where the Bartholin and Skene duct openings sit, and where normal vestibular papillae are found.
• Vagina, the canal itself: no hair and no oil glands, so cysts arising there are of a different kind and are usually noticed during an examination rather than felt by hand.

The distinction is not pedantry. It narrows the list before anyone has looked. Something felt inside the vagina as a soft bulge that becomes more obvious on straining or by the end of the day is more often prolapse of the vaginal wall than a lump in the skin sense. Pain felt deep in the pelvis rather than on the surface belongs to a different set of causes altogether, covered in our article on ovarian and pelvic pain. A bump you can see and touch on the vulva is the subject here.

Normal anatomy that is often mistaken for a problem

A good share of vulval bumps brought to a gynaecology clinic are normal structures that someone has only just noticed, often after looking closely for the first time or after hair removal made the skin easier to see. Fordyce spots are sebaceous glands sitting close to the surface without a hair to open into. They appear as small cream or pale yellow papules, roughly one to three millimetres across, usually in groups, most obvious on the inner lips or just inside the labia majora when the skin is stretched. They are not tender, they do not itch, and they have usually been present for years.

Vestibular papillae are soft, fine, finger-like projections arranged in a fairly even line around the vaginal opening or along the inner aspect of the inner lips. They are a normal variant of the vestibular lining. They matter because they are among the commonest reasons someone becomes convinced they have genital warts. Papillae are soft, symmetrical, uniform in size and arise each from its own base, while warts tend to be firmer, irregular and clustered on a common base. Even so, this is a distinction made on examination by a clinician, not from a photograph.

Other ordinary structures mistaken for disease include the openings of the Bartholin and Skene ducts, small sebaceous glands scattered over the labia majora, and the slightly raised openings of hair follicles. The general pattern of normal anatomy is that it is longstanding rather than new, symmetrical rather than one sided, uniform rather than varied, and unchanging over weeks. Any bump that fails those tests, by appearing recently, growing, bleeding, ulcerating or hurting, is treated as a finding to be examined rather than as a variation of normal.

Ingrown hairs and inflamed follicles

Hair removal of any kind leaves hair tips blunt and sometimes curling back into the skin, and the hair bearing vulva is also a region of friction, moisture and tight clothing. An ingrown hair produces a small, raised, red or darker bump, sometimes with a visible dark hair coiled under the surface. It may itch, feel sore when touched, or do nothing at all. These bumps typically appear within days of shaving or waxing, sit in the hair bearing area rather than on the inner lips, and tend to come in more than one.

Folliculitis is inflammation of the follicle itself, and it looks like a small pustule centred exactly on a hair, surrounded by a rim of redness that is easier to see on paler skin and may read as darker or purplish on brown and black skin. A follicle that becomes more deeply infected forms a boil, which is a tender, firm, hot lump that enlarges over a day or two and may point and discharge. A boil is painful enough that most people do not need telling that something has changed.

Most of these settle without anything being done, and the sensible response is to stop hair removal in the area until the skin has recovered. What is not ordinary is redness that spreads outwards into surrounding skin, a lump that keeps enlarging over hours, or any of this with a fever or feeling generally unwell. That combination is covered in the section on findings that need prompt assessment, and it should not be watched at home overnight.

One pattern is worth naming separately. Painful, boil-like lumps that keep coming back in the same areas of the groin, the outer lips, the buttocks or under the breasts, especially if any of them have discharged pus, left scars or formed narrow channels under the skin, are not ordinary shaving bumps. That pattern suggests hidradenitis suppurativa, a long-term skin condition that is commoner than most people assume and that affects more women than men. It is managed differently from a one-off boil and often needs specialist input, so recurrent boils in these sites are a reason to be seen, and to say clearly how often they come back, rather than to keep treating each one as a new ingrown hair.

Cysts: Bartholin's cysts and skin cysts

The Bartholin glands lie deep to the labia on either side of the vaginal opening, towards the back, and drain through a short duct. They are not normally felt. If a duct blocks, fluid collects behind it and forms a Bartholin's cyst: a soft or slightly tense, rounded, one sided swelling that may reach a few centimetres. Many are not tender at all, and the first sign is a sensation of fullness on one side, discomfort when sitting, cycling or during intercourse, or simply an asymmetry noticed by hand. One qualification matters: a Bartholin's-type swelling appearing for the first time from around the age of 40 onwards is not assumed to be a simple cyst, because rare tumours of the gland present in exactly that position, and many services will examine it and sample it rather than watch it.

The same gland can become infected, and a Bartholin's abscess behaves completely differently. It enlarges quickly over a day or two, becomes hot, red and tense, and is painful enough to make walking and sitting difficult. Fever may follow. This is a same-day problem rather than a wait-and-see one. Treatment is decided by a doctor who has examined it. Depending on the findings that may mean antibiotics, drainage of the collection, or both, and collections that keep coming back are sometimes managed with a small procedure on the duct. Nothing about that decision can be made from a description or a photograph.

Skin cysts, often called sebaceous or epidermoid cysts, are the other common cystic lump. They sit in the skin of the labia majora rather than beside the vaginal opening, feel firm and mobile under the fingers, look skin coloured or yellowish, and sometimes show a tiny central dot where the blocked opening sits. They grow slowly or not at all, are usually not painful, and can stay unchanged for years. If one becomes inflamed it turns red and tender, and that change is worth showing to a doctor.

Both kinds of cyst can recur after they have been dealt with, and neither is prevented by anything in a washing routine. Recurrent one sided swelling in the same place is itself useful information to bring to an appointment, because it suggests a duct problem rather than a new finding each time.

Skin tags and other harmless growths

Skin tags are soft, skin coloured or slightly darker outgrowths attached by a narrow stalk, so they move freely when touched. They form where skin rubs against skin or clothing, which makes the groin and the outer lips a common site, and they become more frequent with age and with weight gain. They do not hurt unless they catch on underwear or twist, in which case they can become sore and dusky coloured over a day. They are harmless, but removal is a decision for a doctor rather than something to attempt at home.

Angiokeratomas are small dome shaped papules made of dilated blood vessels, dark red, purple or almost black, usually on the labia majora and often multiple. They look alarming and are not dangerous, although they can bleed if scratched or caught. Molluscum contagiosum produces firm, pearly papules about two to five millimetres across with a small shiny central dimple. It spreads through close skin to skin contact, and in adults genital spots are usually passed on sexually. It clears without treatment, although that can take up to around eighteen months. In older skin, seborrhoeic keratoses can appear as rough, stuck-on brown plaques on the outer vulva.

The common thread is that these findings are stable or slowly changing, do not ulcerate and do not bleed without being knocked. A growth that bleeds spontaneously, breaks down into a sore that does not heal, hardens, fixes itself to deeper tissue or keeps enlarging is not assumed to be one of them, whatever it looked like at first, and belongs in the section on prompt assessment below. One uncommon cause deserves naming in the same breath, because it looks like the reassuring pattern rather than the alarming one: a single firm sore or ulcer appearing a few weeks after sex, usually not painful and often the only one, is the way early syphilis shows itself, and its symptoms can come and go while the infection remains. A genital sore that does not hurt is therefore a reason to attend a sexual health clinic for testing rather than a reason to wait and watch.

Genital warts and what they do and do not tell you

Genital warts are growths caused by particular types of human papillomavirus. They can be flesh coloured, whitish or slightly darker than surrounding skin, flat or raised, smooth or with the cauliflower-like surface people expect, and they may be single or appear in clusters. They turn up on the labia, around the vaginal opening, on the perineum and around the anus. Most are not painful. Itching, catching on underwear or bleeding after friction are the usual complaints, and many are noticed by touch before they are seen.

The point that causes most distress is transmission, so it is worth being precise. HPV is extremely common, most people who acquire it clear it without ever knowing, and the interval between acquiring the virus and any wart appearing varies from weeks to a very long time. Because of that variation, it is usually not possible to establish when the virus was acquired or from whom, and warts appearing during a long relationship do not indicate recent exposure. The honest clinical answer to that question is that it cannot be determined, and no inference about a partner should be drawn from the timing.

Treatment exists and is a matter for a doctor or a sexual health clinic: some warts clear without any intervention, and the approach differs depending on the number, the site and what the person prefers, which is why guidance from different bodies describes a choice rather than a single pathway. Tell the clinician if you are pregnant or trying to conceive, because some wart treatments are not suitable in pregnancy and the choice is made differently. Products sold for warts on hands or feet are not intended for genital skin and should not be used there. The HPV types that cause visible warts are generally not the types associated with cervical cancer, and cervical screening continues on whatever schedule the national programme sets.

Herpes lesions look different from a lump

Genital herpes is often included in lists of vulval bumps, but what it produces is usually not a lump in the way people mean. A first episode typically begins with tingling, burning or itching in one area, followed within a day or two by small blisters that break down into shallow, raw ulcers. These are painful, often strikingly so, and passing urine over broken skin can be the worst part. Flu-like symptoms, aching and tender swollen glands in the groin are common with a first episode.

Recurrent episodes behave differently. They tend to be shorter, less painful, confined to a smaller area and often in the same place each time, sometimes with warning symptoms a day beforehand. Some people have frequent recurrences and others have one episode and nothing further. As with HPV, the interval between acquiring the virus and a first episode can be long and unpredictable, so the timing of an outbreak does not establish when or from whom the virus was acquired.

Diagnosis is not made from appearance. The confirmation is a swab taken from a fresh lesion while the blister or ulcer is still present, which is one practical reason to be seen early rather than waiting for things to settle. Antiviral treatment exists and is prescribed by a doctor or a sexual health clinic. If you are pregnant and develop painful blisters or ulcers for the first time, tell your maternity team promptly rather than at the next routine appointment, because the management of a first episode in pregnancy is planned differently.

Lichen sclerosus and vulval skin change

Lichen sclerosus is a long-term inflammatory skin condition that affects the vulva more often than any other site. It is usually described as skin change rather than as a bump, but it reaches this article because the thickened, raised white areas it produces are regularly felt as a lump. The classic appearance is porcelain white, crinkled or shiny skin over the inner lips, clitoral hood and perineum, often in a figure-of-eight pattern. Itch is the dominant symptom and is typically worst at night.

Untreated, it can cause splitting of the skin, soreness with intercourse, and over time scarring that changes the shape of the vulva, with the inner lips flattening or the clitoral hood sealing over. It can appear at any age, including in childhood, but it is most often diagnosed around and after the menopause, when vulval skin is already changing for other reasons, described in our article on the stages and symptoms of menopause. Treatment is prescribed and supervised by a doctor. It cannot cure the condition, but a prescribed steroid ointment usually relieves the itch and soreness. It is managed as a long-term condition under medical review rather than with anything bought over the counter, and your own doctor will say how and when to use whatever is prescribed. That instruction matters, because stopping treatment on your own as soon as the itch settles tends to be followed by a relapse.

Two points matter for anyone with a lump. First, a diagnosis is made by examination, and a biopsy is sometimes taken if the appearance is not typical or if an area does not respond as expected. Second, lichen sclerosus carries a small increase in the chance of vulval cancer developing in affected skin over many years, which is why a new lump, a thickened plaque or a sore that does not heal within affected skin should always be examined rather than attributed to the condition itself.

Guidance differs on how such skin should be followed up. Some specialist services review everyone with lichen sclerosus at set intervals, while others discharge people whose symptoms are well controlled and who are confident examining their own skin, with open access back if something changes. Both approaches are defensible and your own doctor will say which applies locally, so this is a question worth asking directly at diagnosis rather than assuming.

The common findings compared side by side

The table below sets out how these findings usually present. It is a summary of typical patterns, not a diagnostic tool, and the overlap between rows is exactly why examination is needed. Any one of these conditions can present atypically, and more than one can be present at the same time on the same vulva.

Reading across the table, two columns carry most of the information: whether the finding is new or longstanding, and whether it is changing. Pain is a less reliable guide than people expect. Several harmless findings hurt a great deal, and several findings that need assessment do not hurt at all.

Appearance alone does not make the diagnosis

This deserves stating plainly, because it is the single most useful thing in this article. A vulval bump cannot be diagnosed from how it looks, and comparing your own skin against images found online is unreliable to the point of being actively unhelpful. Vestibular papillae are routinely mistaken for warts, molluscum for warts, warts for skin tags, skin tags for warts, a skin cyst for a Bartholin's cyst, and an early herpes episode for an ingrown hair. Clinicians who see vulval skin daily still take swabs and biopsies for this reason.

Photographs confuse the picture for practical reasons as well. Images online are heavily weighted towards severe or unusual examples because those are the ones that get photographed. Lighting, hair and skin tone change the appearance of every finding described here, and most published image sets under-represent brown and black skin, on which redness reads as darker or purplish rather than pink. A finding also evolves over days, so an image captured at one moment may look nothing like the same condition in your own mirror.

What a clinician adds is examination in good light, sometimes with magnification, the ability to feel the lump and judge whether it is mobile or fixed, and access to the tests that actually settle the question. The right response to a new vulval bump is therefore not more searching but an appointment, and nothing about the examination requires you to have looked at it first or to have reached a conclusion of your own.

Lumps that need prompt assessment, not watchful waiting

Most vulval bumps are harmless, but a specific group of findings should be seen quickly rather than monitored, and separating them out is the point of this section. Do not wait for a routine appointment slot, and do not let embarrassment turn a few days into a few months. Contact your own doctor, a gynaecology service or a sexual health clinic the same day if any of the following apply. Use emergency care straight away if you cannot pass urine, or if you have a fever or spreading redness and feel unwell with it.

• A lump that is enlarging rapidly over hours or days rather than weeks.
• A very painful swelling, particularly one that makes sitting or walking difficult, which may be an abscess.
• Any lump or swelling together with fever, shivering or feeling generally unwell, or with redness spreading outwards into surrounding skin.
• Inability to pass urine at all, which needs emergency assessment straight away rather than a same-day appointment: go to an emergency department or call your local emergency number. Severe pain on passing urine because of broken skin should also be seen the same day.
• Any open sore, ulcer or raw area on the vulva that you cannot account for. Do not wait to see whether it heals: some ulcers that need treatment heal on their own and still need diagnosing, and swabs only give a clear answer while the lesion is still present. A sore that has not healed within three weeks needs assessment in all cases.
• A lump that bleeds without being knocked, or that feels hard and fixed to the tissue beneath it.
• Any new lump, thickened area or persistent itch on the vulva after the menopause.
• A new lump alongside unexplained vulval or vaginal bleeding.

The post-menopausal entry is on the list even when the lump is causing no pain at all, and that is deliberate. A new lump, a persistent sore or an area of thickened skin on the vulva after the menopause is the pattern that prompts referral for further assessment, and it is seen promptly precisely because it does not hurt and therefore tends to be left. The findings that actually change what happens next are a sore that will not heal, a lump that keeps growing and bleeding that has no obvious cause. Acting on those rather than waiting is the part within your control.

None of this means a lump is likely to be serious. The great majority turn out to be cysts, follicles, normal anatomy or skin conditions that are straightforward to manage. It means that being checked and reassured takes one appointment, while waiting on the wrong finding can mean a worse problem later, and your own doctor is the person to make that judgement rather than a search result.

What assessment usually involves

An appointment for a vulval lump is generally short and straightforward. You will be asked when the bump appeared, whether it has changed, whether it hurts, whether anything similar has happened before, what you use on the skin and whether you remove hair. A chaperone can be requested for the examination, and you can ask to see what the clinician is describing with a mirror. Many findings are settled at that point without anything further being needed.

• Examination of the vulva in good light, and of the vagina and cervix if the history suggests it is needed.
• Swabs if infection is possible, taken from a fresh lesion where one is present, because an older healing lesion is less likely to give a clear result.
• A small biopsy taken under local anaesthetic if the appearance is not typical, if a skin condition is suspected or if an area has not healed.
• Imaging only occasionally, for a deeper swelling where the clinician wants to know what lies beneath the skin.

It is worth noting before you go that guidance from different bodies is written for different audiences and reads differently as a result. Patient information from the NHS is organised around what to look for and when to seek help, patient information from bodies such as ACOG is organised condition by condition, and specialist guidelines written for clinicians are organised around examination and treatment thresholds. They do not conflict on the findings that matter, but the emphasis differs, and that is one reason the same bump can be described slightly differently in two places you read.

The sensible conclusion is the simplest one. A bump on the vulva that is longstanding, symmetrical, free of pain and unchanged is very often normal anatomy. A bump that is new, one sided, growing, ulcerating, bleeding or appearing after the menopause is a reason to be examined. Everything in between is decided by someone looking, and the decision belongs to the doctor who knows your history rather than to an article, however detailed.

Related Reading

• Vaginal odour (vaginal odor): the common causes and what each pattern means
• Discharge after period: brown, white, clear and what is not expected
• What is menopause? The stages, symptoms and age range explained
• White discharge before your period: why it happens and when to check
• Ovarian pain: what causes it, and when it needs urgent assessment
• UTI vs yeast infection: how to tell the difference

Sources and references

This article is supported by the following independent, authoritative sources:

• NHS, Bartholin's cyst
• NHS, genital warts
• NHS, genital herpes
• NHS, lichen sclerosus
• ACOG, Disorders of the Vulva
• Cancer Research UK, symptoms of vulval cancer