Vulvar Hidradenitis Suppurativa: Causes, Treatment, and More

Talking about skin problems is hard. Talking about skin problems on the vulva can feel almost impossible.
But if you’ve noticed painful lumps, draining bumps, or scars on or around your vulva, you might be dealing
with a condition called vulvar hidradenitis suppurativa (HS)and you absolutely deserve clear
information and compassionate care.

Hidradenitis suppurativa is a chronic inflammatory skin disease that causes deep, painful nodules, abscesses,
and tunnels (sinus tracts) in areas where skin rubs on skin, like the armpits, groin, buttocks, and under the
breasts. When those lesions appear on or near the vulva, they bring unique physical, emotional, and sexual
challenges.

The good news: While there’s currently no cure, there are effective ways to manage symptoms, reduce flares,
and protect your long-term health. Let’s walk through what vulvar HS is, why it happens, how it’s treated, and
what day-to-day life can look like with this condition.

What Is Vulvar Hidradenitis Suppurativa?

Vulvar hidradenitis suppurativa is HS that specifically affects the vulvathe external genital area,
including the labia, mons pubis, and nearby groin folds. It may show up as:

• Painful, pea- to grape-sized lumps under the skin
• Warm, tender nodules that may feel like deep pimples or boils
• Abscesses that drain blood or pus
• Recurrent lesions that keep coming back in the same spots
• Sinus tracts (tunnels under the skin) and scarring over time

Because the vulva is a high-friction, high-moisture area with hair follicles and specialized glands, it’s a
classic “hot spot” for HS, along with the groin, underarms, and perianal region.

How Vulvar HS Differs From “Regular” HS

The basic disease process is the same wherever HS shows upbut vulvar involvement has a few extra layers:

• Misdiagnosis is common. Vulvar HS can be mistaken for recurrent Bartholin’s cysts, sexually transmitted infections (STIs), ingrown hairs, or “just shaving bumps.”
• Intimacy can be painful. Lesions may make sex, tampon use, or even tight clothing uncomfortable.
• Urination and hygiene may be harder. Painful nodules can make wiping, sitting, or wearing pads difficult.
• There may be a link to anogenital cancers. Chronic inflammation in vulvar HS has been associated with an increased risk of certain anogenital cancers, which makes regular monitoring especially important.

In other words: vulvar HS isn’t “just a skin thing.” It touches sexual health, self-esteem, relationships, and
quality of life in a big way.

Causes and Triggers of Vulvar Hidradenitis Suppurativa

What Actually Causes HS?

HS used to be blamed on “infected sweat glands,” but current research points to a more complex picture. Experts
now think HS is primarily a problem of hair follicles in areas rich in apocrine glands (like the groin and vulva).
The basic sequence looks like this:

1. Hair follicles become blocked (follicular occlusion).
2. The follicle stretches, weakens, and eventually ruptures.
3. Leaked follicular material triggers an intense inflammatory immune response.
4. Chronic inflammation leads to nodules, abscesses, tunnels, and scarring.

HS is not contagious. It’s not caused by poor hygiene, and it’s not your fault. Genetics and
immune dysregulation appear to play major roles, and HS often coexists with other inflammatory conditions like
inflammatory bowel disease and metabolic syndrome.

Risk Factors and Common Triggers

Several factors seem to increase the risk of HS or worsen flares:

• Sex and age: HS is more common in women and often starts after puberty, typically in the teens or 20s.
• Family history: Up to one-third of people with HS have an affected relative, suggesting a genetic component.
• Smoking: Strongly associated with HS and may make symptoms more severe.
• Obesity or higher body weight: More skin friction and systemic inflammation can worsen flares.
• Hormones: Many people report flares around their menstrual cycle, pregnancy, or hormonal changes.

On the vulva specifically, you might notice patterns with:

• Shaving or waxing the pubic area
• Wearing tight underwear, leggings, or synthetic fabrics
• Prolonged sitting, biking, or friction-heavy activities
• Heat, sweating, or humid climates

Symptoms of Vulvar Hidradenitis Suppurativa

Early on, vulvar HS may look like “just one weird painful bump.” Over time, though, a clearer pattern often appears.
Common symptoms include:

• Deep, tender nodules near the vulva, groin folds, or inner thighs
• Lesions that come back in the same areas again and again
• Abscesses that may drain spontaneously or require medical drainage
• Itching, burning, or stinging sensations in the area
• Noticeable odor from chronic drainage under the skin
• Thickened, rope-like scars or pits over time
• Pain during walking, sexual activity, or even simple sitting

Dermatologists sometimes use the Hurley staging system to describe HS:

• Stage I: Isolated nodules or abscesses with no tunnels or scarring.
• Stage II: Recurrent lesions with limited sinus tracts and scarring.
• Stage III: Extensive scarring and interconnected tracts across a large area.

You can have one Hurley stage on the vulva and a different stage in other body areas, so a full-skin exam can be very helpful.

How Vulvar HS Is Diagnosed

There’s no single lab test or biopsy finding that “proves” HS. Diagnosis is based on three main clues:

1. Typical lesions: Painful nodules, abscesses, tunnels, and scars.
2. Typical locations: Areas where skin rubsvulva/groin, underarms, buttocks, under breasts.
3. Chronic or recurrent course: Lesions that come back at least twice in 6 months.

For vulvar HS, you may see:

• A gynecologist who focuses on pelvic and vulvar health
• A dermatologist with experience in HS
• Sometimes a combined team, especially if disease is severe

Your provider might:

• Take a detailed history of your symptoms and flares
• Examine your vulva, groin, and other skin folds
• Swab fluid from lesions to rule out bacterial or STI causes
• Order a biopsy if a lesion looks suspicious for cancer or another skin disease

Because HS is still under-recognized, many people see multiple providers or are misdiagnosed for years, which can be emotionally exhausting. Knowing the name “hidradenitis suppurativa” and bringing it up at appointments can sometimes speed up the process.

Treatment Options for Vulvar Hidradenitis Suppurativa

While there’s currently no cure for HS, treatments can reduce pain and drainage, shrink lesions, prevent new flares,
and improve quality of life. Most people need a combination of lifestyle changes, medicines, and sometimes procedures.

Lifestyle and Self-Care Strategies

Think of lifestyle changes as the “foundation” of HS care. They may not replace medical treatment, but they can make
a real difference:

• Quit smoking (or cut back as much as you can). Smoking is strongly tied to HS severity, and quitting is one of the most powerful things you can do for your skin and overall health.
• Support a healthy weight. Even modest weight loss can reduce skin friction and systemic inflammation. Ask your provider for realistic, sustainable options.
• Choose gentle vulvar care. Use fragrance-free, dye-free cleansers; avoid scrubbing; skip harsh soaps inside the vaginal canal (it cleans itself).
• Wear breathable clothing. Opt for cotton underwear, looser pants, and avoid seams that press directly on lesions.
• Use warm compresses or sitz baths. These can help relieve pain and encourage drainage from superficial lesions.
• Manage pain wisely. Over-the-counter NSAIDs (like ibuprofen or naproxen) or acetaminophen may help, but talk with your provider about what’s safe for you and how often you can take them.

Medical Treatments

Your dermatologist or gynecologist may recommend one or more medications depending on your disease stage and symptom pattern:

• Topical antibiotics: Clindamycin 1% solution or gel is often used for mild HS to reduce bacteria and inflammation on the skin surface.
• Oral antibiotics: Tetracycline-class drugs (like doxycycline or minocycline) or combination regimens (such as clindamycin plus rifampin) may be prescribed for moderate HS to calm inflammation and treat secondary infection.
• Hormonal therapies: For people whose HS seems linked to hormonal cycles, options like combined birth control pills, spironolactone, or other anti-androgen therapies may help reduce flares in the vulvar and groin area.
• Biologic medications: Adalimumab (a TNF-α inhibitor) is FDA-approved for HS and can significantly reduce flare frequency and severity in many patients; other biologics are being studied as well. These target immune pathways driving inflammation.
• Corticosteroid injections: Injecting steroids directly into a large, painful nodule may help it shrink and calm down more quickly.

Because vulvar tissue is delicate, medication choices and dosing may be adjusted to balance effectiveness with comfort and safety.

Procedures and Surgery

When HS causes frequent abscesses, extensive scarring, or stubborn sinus tracts, procedural treatments can be very helpful:

• Incision and drainage: Can provide short-term relief for a painful abscess, but by itself it doesn’t “fix” HS and lesions often recur.
• Deroofing: A targeted procedure that opens sinus tracts and removes the “roof” of tunnels and chronic lesions while preserving as much healthy tissue as possible.
• Wide local excision: For advanced disease, entire affected areas of skin may be surgically removed, sometimes with grafts or flaps to reconstruct the vulvar area.
• Laser therapies: Certain lasers can remove hair follicles and diseased tissue, reduce inflammation, and decrease flares. Laser hair removal, when performed by an experienced dermatologist, may be helpful for early-stage HS in hair-bearing areas like the groin and mons pubis.

Surgical planning around the vulva is delicate, so it’s important to work with specialists familiar with both HS and vulvar anatomy.

Mental Health and Sexual Health Support

HS doesn’t just affect skinit affects mood, confidence, and relationships. Studies consistently show high rates of
depression, anxiety, and reduced quality of life among people living with HS.

Helpful supports can include:

• Seeing a therapist, especially one familiar with chronic illness or sexual health
• Couples counseling to help partners navigate pain, intimacy, and communication
• Support groups (online or in person) where you can connect with others who “get it”

You deserve care for both your skin and your emotional well-beingthose are equally important parts of your treatment plan.

Living With Vulvar HS: Everyday Tips

Managing vulvar HS often means making small, practical adjustments that add up over time. Some ideas to discuss
with your care team:

• Choose soft, breathable underwear. Seamless cotton or modal fabric can reduce rubbing on lesions.
• Skip harsh hair removal. If shaving triggers flares, consider trimming insteador talk to a dermatologist about safe laser options.
• Rethink period products. If pads cause friction, you might prefer period underwear or cups (if comfortable and cleared by your provider).
• Use barrier ointments. A thin layer of petroleum jelly or similar product around high-friction areas can reduce rubbing during daily activities.
• Plan for flares. Keep supplies on handnon-stick dressings, comfortable underwear, pain relieversso you’re not scrambling when a lesion pops up.
• Track triggers. A simple symptom diary can help you notice patterns with stress, hormones, foods, or activities.

Possible Complications of Vulvar HS

Untreated or severe HS can lead to complications such as:

• Significant scarring and distortion of vulvar anatomy
• Chronic pain that interferes with walking, sitting, or sex
• Fistulas (abnormal connections) between the vulva and nearby structures
• Recurrent infections and cellulitis
• Urinary difficulties if lesions are close to the urethra
• Rarely, an increased risk of anogenital squamous cell carcinoma in long-standing, severe disease

Regular gynecologic and dermatologic follow-up is essential, especially if you’ve had vulvar HS for many years or
notice any new, different, or non-healing lesions.

When to See a Doctor Right Away

Call a health professional promptly if you notice:

• Sudden worsening pain, redness, or swelling
• Fever, chills, or feeling very unwell
• Rapidly spreading redness around existing lesions
• New bleeding, growths, or ulcers that look different from your usual HS lesions
• Difficulty urinating or severe pain during urination

These can be signs of infection or other complications that need urgent evaluation.

Real-Life Experiences With Vulvar Hidradenitis Suppurativa

Every person’s journey with vulvar HS is unique, but many stories share similar themes: delayed diagnosis, frustration,
relief at finally having a name for what’s going on, and a gradual process of figuring out what works.

Some people describe their first vulvar HS flare as a “mysterious boil” that showed up out of nowhere and made sitting
almost impossible. They went to urgent care, were told it was an abscess, had it drained, and went homeonly for another
bump to appear a few months later in almost the same spot. This cycle repeated for years before anyone mentioned HS.

Others talk about feeling deeply embarrassed. Because the lesions are in such an intimate area, they delay seeking care
as long as they can. They worry that a provider will judge their hygiene, sexual activity, or weight. Some are incorrectly
told it’s an STI, which can add shame and strain relationships, especially if tests keep coming back negative and the bumps
keep returning anyway.

A common turning point is finding a dermatologist or gynecologist familiar with HS. Finally hearing, “You’re not dirty,
and this isn’t your faultthis is a chronic inflammatory condition called hidradenitis suppurativa,” can be incredibly
validating. For many, that’s the moment they start to see a treatment plan instead of just a string of painful emergencies.

People living with vulvar HS often describe experimenting with small changes that help them feel more in control:

• Switching from tight synthetic underwear to soft cotton styles
• Choosing loose dresses or joggers instead of skinny jeans on flare days
• Using a handheld shower sprayer or sitz bath instead of rough wiping when lesions are very tender
• Keeping a “flare kit” with dressings, pain relief, and comfortable underwear ready to go

Many also talk about the emotional work of reclaiming their bodies. That might mean opening up to a partner about why
sex sometimes hurts, what positions feel better, or why they might need to pause intimacy during a flare. It might mean
seeing a therapist to process years of embarrassment, or joining an online community where people trade practical tips
and, just as importantly, encouragement.

None of this magically makes HS easy, but having language, support, and a plan often turns the condition from something
that feels chaotic and shameful into something that’s challengingbut manageable. People with vulvar HS work, parent,
date, travel, exercise, and live full lives. The condition is real and serious, but it does not define you.

If you recognize yourself in these experiences, consider this your nudge to bring up HS at your next appointment.
You deserve providers who take your pain seriously and work with you to build a treatment plan that fits your body,
your values, and your goals.

The Bottom Line

Vulvar hidradenitis suppurativa is a chronic inflammatory skin disease that shows up in a uniquely sensitive place,
but you are far from alone. With the right diagnosis, a mix of lifestyle changes and medical treatments, and support
for your mental and sexual health, many people find meaningful relief and regain confidence in their bodies.

This article is for general information only and is not a substitute for personal medical advice. If you suspect you
may have vulvar HSor if you’re struggling with painful or recurrent vulvar lesionsreach out to a qualified healthcare
professional for an evaluation and tailored treatment plan.