Differential Diagnosis for Painful Sore on Inner Labia that is Friable
- Single Most Likely Diagnosis
- Genital Herpes: This is a common sexually transmitted infection caused by the herpes simplex virus, characterized by painful, friable sores on the genital area, including the inner labia. The friability and pain are key features that align with this diagnosis.
- Other Likely Diagnoses
- Syphilitic Chancre: The primary stage of syphilis can present with a single, painful sore (chancre) that can be friable, although it's typically not as multiple or widespread as in herpes. It's a consideration due to its potential for serious complications if left untreated.
- Bartholin's Gland Abscess or Cyst: While not typically described as friable, an infected Bartholin's gland can cause a painful swelling that might be mistaken for a sore. The location near the vaginal opening and the potential for abscess formation make it a plausible differential.
- Vulvar Ulcer from Other Causes (e.g., traumatic, aphthous): Ulcers from trauma or aphthous ulcers can appear on the vulva, including the inner labia, and might be painful and friable, depending on their cause and stage.
- Do Not Miss Diagnoses
- Malignancy (e.g., Vulvar Cancer): Although rare, any persistent or non-healing ulcer on the vulva, especially in older women or those with risk factors (like lichen sclerosus or HPV infection), should prompt a consideration of vulvar cancer. The friability could be a sign of tumor ulceration.
- Lymphogranuloma Venereum (LGV): This is a sexually transmitted infection caused by certain strains of Chlamydia trachomatis, which can lead to painful lymphadenopathy and, in some cases, genital ulcers. It's less common but can have significant morbidity if not treated.
- Rare Diagnoses
- Behçet's Disease: A rare autoimmune disorder that can cause a variety of symptoms, including genital ulcers that are painful and might appear friable. It's part of a broader syndrome that includes oral ulcers and ocular inflammation.
- Crohn's Disease or Ulcerative Colitis with Perineal Involvement: These inflammatory bowel diseases can rarely cause perineal disease, including painful, friable ulcers in the genital area due to fistulae or direct extension of the disease.