Vulvar Hidradenitis Suppurativa: When Recurring Vulvar Lumps Could Be HS

A painful lump on the vulvaVulva: The external female genital area, including the outer and inner labia, clitoral region, and the tissue around the vaginal opening. HS can affect the hair-bearing outer vulva and adjacent groin skin in particular, but a recurring lump there has several possible causes, including a Bartholin cyst, folliculitis, or an infection.VulvaThe external female genital area, including the outer and inner labia, clitoral region, and the tissue around the vaginal opening. HS can affect the hair-bearing outer vulva and adjacent groin skin in particular, but a recurring lump there has several possible causes, including a Bartholin cyst, folliculitis, or an infection.Read more in the glossary does not automatically mean hidradenitis suppurativa (HS). There are several possible causes.

But if painful lumps, abscessAbscess: An inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds.AbscessAn inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds.Read more in the glossary-like swellings, or draining areas keep returning — particularly on hair-bearing outer vulvar skin, or alongside similar lesions in the groin, inner thighs, armpits, buttocks, or under the breasts — HS is worth raising as part of the conversation with a clinician.

HS can affect the vulva. A 2025 German dermatologyDermatology: The medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.DermatologyThe medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.Read more in the glossary review identifies the vulva as one of the recognised HS sites in women and notes that vulvar involvement can substantially affect quality of life and sexual function. The challenge is that vulvar HS can resemble several other conditions, including Bartholin cysts or abscesses, folliculitis, other cysts, Crohn-related vulvar disease, and infections.

You do not need to work out which one you have yourself. The useful task is recognising whether there is a recurring pattern, and describing that pattern clearly to whoever examines you.

What does “vulvar HS” mean?

The vulva is the external genital area. It includes structures such as the outer labia (labia majora), inner labia (labia minora), the clitoral region, the tissue surrounding the vaginal and urethral openings, and adjacent perineal skin.

HS is a chronic inflammatory disease centred on the hair follicleHair Follicle: The tube-shaped pocket in the skin from which a hair grows. In Acne Inversa, the follicle becomes plugged and eventually ruptures, spilling its contents into surrounding tissue and triggering the inflammatory cascade that defines the disease.Hair FollicleThe tube-shaped pocket in the skin from which a hair grows. In Acne Inversa, the follicle becomes plugged and eventually ruptures, spilling its contents into surrounding tissue and triggering the inflammatory cascade that defines the disease.Read more in the glossary. It tends to develop in hair-bearing, friction-prone skin folds — in women, recognised locations include the inner thighs, armpits, the fold under the breasts, and the vulva. Because parts of the vulva contain terminal hair follicles and experience friction, HS can occur there. That does not mean every part of the vulva is equally typical: largely hairless mucosal surfaces are a much less common site for follicular HS than the hair-bearing outer vulva and groin.

What can vulvar HS look or feel like?

Vulvar HS can involve the same kinds of lesions seen elsewhere with HS: deep painful nodulesNodule: A firm, palpable lump deep in tissue. Nodules can be painful and may progress to abscesses. They are among the typical early signs of Acne Inversa.NoduleA firm, palpable lump deep in tissue. Nodules can be painful and may progress to abscesses. They are among the typical early signs of Acne Inversa.Read more in the glossary, abscess-like swellings, recurrent drainage, tunnelsSinus Tract: A tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Sinus TractA tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Read more in the glossary beneath the skin, scarring, and repeated lesions returning to the same general area.

The location can make symptoms particularly disruptive. People may find walking, sitting, tight clothing, exercise, sexual activity, wound dressings, and hygiene routines all affected. Published reviews describe substantial quality-of-life and sexual-function burden when vulvar disease is involved — this is a meaningful part of HS, not a minor variant of it.

What makes HS more likely than a one-off cyst?

No single feature diagnoses HS. The pattern over time is what matters.

Recurrence. A lump that settles and similar lesions return weeks or months later is more relevant to HS than one isolated event.

Multiple sites. HS becomes more plausible when similar lesions also occur in the armpits, groin folds, inner thighs, under the breasts, buttocks, or other recurring intertriginous areas.

Scarring. Previous inflammation may leave raised or indented scars, pigment changes, or persistent openings.

Tunnels. Repeated inflammation can create channels under the skin connecting two or more openings.

The same area keeps returning. A recurring lesion at the same site is a particularly useful detail for a clinician.

None of these alone proves HS. Together, they build a pattern that deserves dermatologic assessment.

Could it be a Bartholin cyst instead?

Yes — this is one of the most important alternatives to consider. The Bartholin glands sit on either side of the vaginal opening and produce lubricating fluid. If the duct becomes blocked, fluid can accumulate as a Bartholin cystBartholin Cyst: A build-up of fluid in one of the Bartholin glands, which sit beside the vaginal opening and produce lubricating fluid. If the duct becomes blocked, a cyst can form; if it becomes infected, a painful abscess can develop. A Bartholin cyst is usually one-sided and separate from hidradenitis suppurativa, though the two can also occur together.Bartholin CystA build-up of fluid in one of the Bartholin glands, which sit beside the vaginal opening and produce lubricating fluid. If the duct becomes blocked, a cyst can form; if it becomes infected, a painful abscess can develop. A Bartholin cyst is usually one-sided and separate from hidradenitis suppurativa, though the two can also occur together.Read more in the glossary; if it becomes infected, a painful abscess can form. A Bartholin cystCyst: A fluid- or keratin-filled sac under the skin. In Acne Inversa some lesions resemble epidermoid cysts but differ histologically. The term is used loosely in clinical practice.CystA fluid- or keratin-filled sac under the skin. In Acne Inversa some lesions resemble epidermoid cysts but differ histologically. The term is used loosely in clinical practice.Read more in the glossary or abscess typically appears as a lump near the vaginal opening and commonly affects one side.

HS is different because it tends to be part of a broader, recurring follicular pattern rather than a single-gland problem.

A simplified comparison, for context rather than self-diagnosis:

Bartholin-gland disease is often one-sided, close to the vaginal opening, centred on the Bartholin-gland region, and may occur as a cyst or an acute abscess.

HS is more often recurrent over time, associated with hair-bearing vulvar and groin skin, may involve several separate areas at once, may coexist with lesions in the armpits, inner thighs, breasts, or buttocks, and may leave tunnels and characteristic scars.

Actual anatomy can be difficult to judge yourself, especially during a painful, swollen episode — this comparison is meant to help you describe what you notice, not to replace an examination.

Does a Bartholin abscess mean I don’t have HS?

No. The two can coexist. A person with established HS can also develop an ordinary Bartholin-gland problem — having one does not protect against the other. That is why it is unhelpful to automatically relabel every new vulvar lump as “another HS flareFlare: A period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.FlareA period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.Read more in the glossary.” If a lump is in a different location from your usual HS, or behaves differently, it is worth having it looked at rather than assumed.

Could it simply be folliculitis?

Possibly. Folliculitis is inflammation or infection affecting individual hair follicles. It can cause small red or painful bumps on the outer labia, and it is often associated with shaving, waxing, or friction.

Superficial folliculitis tends to be more limited than established HS. HS lesions often sit deeper, are more painful, recur repeatedly, persist longer, occur across several characteristic locations, and can eventually form scars or tunnels in some people. Visual appearance can still overlap, so this is not a reliable way to tell them apart from a photograph or a quick look — it is a reason to mention the history, not to guess.

What about an ingrown hair?

An ingrown hair can cause a localized painful bump, and again, one event is less informative than a history. Ask yourself whether this is one isolated shaving-related bump, or whether painful lesions keep returning even when grooming habits change. If recurrence continues over months or years, especially at multiple HS-prone locations, that pattern is worth mentioning to a clinician.

Could it be an infection?

Some infections can cause vulvar lumps, sores, or inflammation, and a published review of vulvar HS specifically lists several infectious conditions in its differential diagnosisDifferential Diagnosis: The list of other conditions a doctor must rule out before settling on Acne Inversa. Includes: simple recurrent furunculosis, cystic acne, MRSA infections, cutaneous Crohn's disease, pilonidal sinus disease, lymphogranuloma venereum, tuberculosis, and actinomycosis.Differential DiagnosisThe list of other conditions a doctor must rule out before settling on Acne Inversa. Includes: simple recurrent furunculosis, cystic acne, MRSA infections, cutaneous Crohn's disease, pilonidal sinus disease, lymphogranuloma venereum, tuberculosis, and actinomycosis.Read more in the glossary. This is not something to work out through symptom checklists at home. Tell the clinician about any new sores, unusual dischargeDischarge / Exudate: Fluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.Discharge / ExudateFluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.Read more in the glossary, recent sexual-health concerns, systemic symptoms (like fever), or other relevant context — testing may be needed when an infection is part of the differential.

Could Crohn’s disease affect the vulva?

Yes. Cutaneous or anogenital Crohn’s disease can sometimes resemble HS, and HS itself is associated with a higher rate of inflammatory bowel diseaseInflammatory Bowel Disease (IBD): Crohn's disease and, less commonly, ulcerative colitis. Acne Inversa patients have a several-fold higher risk of IBD than the general population. If you have HS and unexplained chronic diarrhoea, weight loss, abdominal pain, or perianal disease, a gastroenterology referral is warranted.Inflammatory Bowel Disease (IBD)Crohn's disease and, less commonly, ulcerative colitis. Acne Inversa patients have a several-fold higher risk of IBD than the general population. If you have HS and unexplained chronic diarrhoea, weight loss, abdominal pain, or perianal disease, a gastroenterology referral is warranted.Read more in the glossary. The published differential diagnosis for vulvar HS specifically includes cutaneous Crohn’s disease.

If vulvar or perianal disease occurs alongside persistent diarrhoea, abdominal pain, rectal bleeding, or known inflammatory bowel disease, mention this to your clinician. Our guide to HS and Crohn’s disease covers the perianal overlap in more detail. Gastrointestinal symptoms alone do not prove Crohn’s disease — they simply broaden the clinical picture worth discussing.

Can HS affect the inner labia?

Classic HS is a follicular disease, so it more typically affects hair-bearing outer vulvar and adjacent fold skin than largely hairless mucosal surfaces. Current German vulvar-dermatology literature specifically notes that hairless regions are rarely affected by HS. A lesion occurring mainly on a hairless inner surface deserves careful clinical assessment for other causes as well — this is a useful clue, not an absolute rule.

Why is vulvar HS often confusing?

Several things converge to make this area harder to diagnose than more typical HS sites.

Different specialties often see different pieces of the picture: a vulvar abscess may be treated by gynecology, an armpit lesion by dermatology, and a groin lump in primary care — nobody necessarily connects them unless the patient, or the record, joins the dots.

The same recurring process may have previously been labelled a boilBoil (Furuncle): Patient-community term for an inflammatory nodule or abscess. Important caveat: an ordinary single boil (furuncle) is a one-off bacterial hair-follicle infection. The recurring, multifocal 'boils' of Acne Inversa are not the same thing — this misdiagnosis is a main reason HS goes unrecognised for years.Boil (Furuncle)Patient-community term for an inflammatory nodule or abscess. Important caveat: an ordinary single boil (furuncle) is a one-off bacterial hair-follicle infection. The recurring, multifocal 'boils' of Acne Inversa are not the same thing — this misdiagnosis is a main reason HS goes unrecognised for years.Read more in the glossary, an abscess, a cyst, an infected hair, or folliculitis at different points, using different words each time.

HS also fluctuates — a clinician may see only scars from an episode that was severe two weeks earlier — and the location itself is one people may hesitate to describe fully because of privacy or embarrassment. All of these contribute to diagnostic delayDiagnostic Delay: The average time between first symptoms and a correct Acne Inversa diagnosis. Repeatedly measured at roughly 7 to 10 years in international studies. Reducing this delay is one of the single most important advocacy goals in the HS field.Diagnostic DelayThe average time between first symptoms and a correct Acne Inversa diagnosis. Repeatedly measured at roughly 7 to 10 years in international studies. Reducing this delay is one of the single most important advocacy goals in the HS field.Read more in the glossary, which remains a well-documented, unresolved problem in HS more broadly.

Should I see a gynecologist or a dermatologist?

It depends on the problem, not on a fixed rule.

A gynecologist (or primary care) can be appropriate when you have a new painful vulvar lump and don’t know what it is, when a Bartholin cyst or abscess is possible, when the lesion sits close to the vaginal opening, when other gynecological symptoms are present, or when you need acute assessment.

A dermatologist becomes particularly important when lesions repeatedly return, when several typical HS locations are involved, when you have tunnels or scars, when HS has already been diagnosed, or when you need long-term disease management.

Sometimes both are useful together. Vulvar HS sits at the intersection of dermatology and gynecology, and current German vulvar-dermatology literature specifically highlights that vulvar inflammatory diseases can cross these specialty boundaries. The goal is not finding the single “correct” specialty in the abstract — it is having the lesion examined and making sure the overall recurring pattern gets recognised. Our guide on which doctor is responsible for HS covers this navigation question more broadly.

When should a painful vulvar lump be assessed promptly?

Seek timely assessment if a vulvar lump becomes rapidly larger or increasingly painful, causes marked swelling, produces pus, is accompanied by fever or feeling generally unwell, or is otherwise clearly different from your usual pattern. Current Bartholin-cyst guidance names increasing pain, swelling, pus, and systemic illness as reasons for urgent assessment, since an abscess may need treatment. These features flag an acute problem worth examining — they don’t by themselves distinguish HS from another kind of abscess.

Do not rely on draining a lump yourself at home to work out what it is. If a lesion repeatedly needs draining, that repeated history is itself useful information to bring to a clinician.

What should I tell the clinician?

The most useful information is your timeline, not a guess at the diagnosis. Try something like: “This is the third painful lump in this area in the past year,” and add detail such as “I also get similar lumps in my armpit, groin, or inner thigh,” “previous lesions have drained and left scars,” or “this lump is different from my usual HS and sits right beside the vaginal opening.” Statements like these give a clinician far more to work with than a description of what the lump looks like today.

What to document

If recurring disease is the concern, it helps to record the date a lesion appeared; the general area (outer labia, mons pubis, groin fold, inner thigh, near the vaginal opening, perineal area — anatomical precision isn’t necessary); what happened (a deep lump, swelling, drainage, a wound, spontaneous improvement, or medical drainage); whether lesions occurred elsewhere around the same time; and whether something similar has happened at that same spot before.

→ Add episodes to the Symptom Tracker to keep this chronology organised between appointments — it’s built to help document a pattern, not to decide whether it’s HS.

Photographs can help document a lesion that has settled by the time of your appointment, but they cannot reliably distinguish HS from Bartholin disease, folliculitis, Crohn-related disease, infection, or other vulvar disorders. If you store intimate images, use a system whose privacy model you understand, and share them only with your care team.

A note on community support

No intimate image is needed to take part in peer support, and other patients — however experienced — cannot diagnose a vulvar lesion from a description or a photo. If you want to talk through the experience with others who understand it, focus on things like preparing for appointments, clothing and dressings, the emotional burden, or navigating between gynecology and dermatology, and leave the diagnostic question for your clinician.

Does treatment differ because the HS is vulvar?

The underlying treatment framework stays based on inflammatory activity, tunnels and scarring, disease distribution, previous treatment, and your own goals — the same factors used everywhere else in HS. Vulvar anatomy can make procedural planning more complex and can increase the value of multidisciplinary input, but the location does not call for an entirely separate treatment algorithm.

Improvement after a course of antibiotics doesn’t settle the question either way: antibiotics are used in HS for both antimicrobial and anti-inflammatory reasons, and they’re also used for some infectious abscesses, so a response to them doesn’t prove it “was an infection” or “was definitely HS.”

What if previous episodes were called Bartholin abscesses?

Bring those previous diagnoses to your appointment, and ask whether the location and recurring pattern still fit repeated Bartholin disease, or whether HS should also be considered. That’s a reasonable question to raise — it doesn’t mean earlier clinicians were wrong. Repeated Bartholin disease genuinely exists; the point is to revisit the picture if the broader history has changed since those earlier episodes.

Five clues worth mentioning when HS is being considered

The lesions recur. More than one typical body area is affected. Old lesions have left scars or persistent openings. Some areas drain repeatedly, or seem connected beneath the skin. The current problem feels like part of a longer pattern rather than a single isolated vulvar cyst.

None of these alone confirms HS — together, they help a clinician see the pattern across time rather than just the lesion in front of them today.

What this article does not mean

This guide is not saying that every vulvar cyst is HS, that every recurrent vulvar abscess is HS, that a Bartholin cyst rules out HS, that known HS makes every new vulvar lesion HS by default, that vulvar HS can be diagnosed from photographs, that gynecologists cannot diagnose HS, that dermatologists are the only clinicians who should assess vulvar disease, or that every part of the vulva is equally typical for HS. The purpose is to improve the history you bring to an appointment and help you find the right care pathway — not to replace an examination.

The bottom line

HS can affect the vulva, but painful vulvar lumps have several possible causes, and one lump is not enough to establish hidradenitis suppurativa. The most useful clue is usually recurrence within a broader pattern: painful lesions returning over time, affecting hair-bearing vulvar and groin skin, and sometimes appearing at other characteristic HS locations. A Bartholin cyst or abscess has a more specific anatomical relationship to the glands beside the vaginal opening, while other infections, follicular disorders, and inflammatory conditions can also look similar.

So the useful action is straightforward: don’t decide from appearance alone — describe the full history. If vulvar or groin lumps keep returning, our diagnosis guide can help you prepare for that conversation, and our directory of HS-experienced clinicians can help you find someone to have it with. You may also find our visual guide to what HS can look like and our broader article on HS in the intimate area useful alongside this one.