When was the last time you took a look down there? At some point, you may have noticed dark or black spots on your vagina, labia or vulva and wondered what they are. But should you be concerned and scheduling a doctor’s appointment right away, or are they just a normal part of getting older? Here’s what you need to know before you hit the panic button — or ignore what could be a sign of a potential health problem.
What are these dark spots?
It’s not uncommon for dark spots to form on the vulva outside the vagina as we age, says Felice Gersh, MD, medical director of the Integrative Medical Group in Irvine, California. Dr. Gersh, author of the book Menopause: 50 Things You Need to Know (buy from Amazon, $16.29), says that like all skin, the vulva, labia and vagina also age and are impacted by hormonal changes at menopause. “This skin aging can result in so-called age spots, and vulvar skin can also show these pigmentary effects.” (Click through for details on another common menopausal symptom: vagina getting smaller after menopause.)
These dark, sometimes black, spots can appear anywhere on the vulva, she says, but they are most common on the labia majora (the larger, fleshy folds of skin often referred to as vaginal lips that surround and protect the vaginal and urethral openings) and the mons pubis (the mound of fatty tissue that covers and cushions the pubic bone). Age spots (also called liver spots) are generally flat but can also be raised, she says, adding that freckles, which can also develop in the pubic area, are flat.
If the spots aren’t age spots, they may be melanoma. “Melanomas can and do develop on vulvar skin, including on the inner and outer surfaces of the labia minora,” says Dr. Gersh. It’s rare, accounting for less than 2% of all melanomas in females, but it does happen. Melanomas often appear as changes in an existing mole, but can also appear as new moles. They can be in shades of black, brown and tan, but can include white, gray, red, pink and blue. These spots have an asymmetrical shape and their edges are often irregular. Dr. Gersh says this type of cancer can be flat or raised.
For more on how to identify and treat red, white or gray spots, click through to our sister publication’s story Is That Bump on Your Vaginal Lips Harmless? A Gynecologist Reveals How To Spot a Boil — And What To Do If You Find One.
When to see a doctor
“Any new pigmented spot should be evaluated by a qualified healthcare provider or physician,” says Dr. Gersh, one of the first dual board-certified integrative gynecologists in the U.S. It’s important to pay attention to any skin changes and discuss them with your gynecologist, as well as schedule yearly check-ups.
And just like you do regular breast self-exams, Dr. Gersh advises doing periodic vulvar “self-checks.” To do: Stand, squat or sit over a handheld mirror so you can clearly see your genitals. Check for moles, spots, sores, bumps, rashes and changes in skin color or texture on the area where your pubic hair grows as well as the clitoris, outer and inner lips of the vulva and the perineum (the space between the vagina and anus). Report anything that looks abnormal or suspicious to your physician.
Other down-there skin changes to look for
These vulvar self-checks may reveal more than black or dark spots, as there are many skin conditions that can crop up around the vagina. Here are a few and what to know about them:
Waxy, brown spots
“Vulvar skin can develop seborrheic keratoses, thickened, waxy brown spots on the surface of the skin,” she says. It’s a fairly common benign growth (meaning it’s not cancerous) and can also appear black or a light tan color. Most people don’t develop seborrheic keratoses until their 50s and older; and your risk also goes up if they run in your family, say experts at the Mayo Clinic. What’s more, if you have one, you’re much more likely to develop others.
Raised, rough growths
Genital warts are most common among people in their 20s, but they can occur at any age, notes Dr. Gersh. They can be dark in color and appear raised and rough. These growths growths often have a bumpy, cauliflower-type look and can also cluster together in groups. They are the result of certain types of human papilloma virus (HPV) that are sexually transmitted, so it’s important to have them diagnosed and treated by your doctor, she says.
Brown bumpy patches
It’s also possible for a pre-cancerous type of seborrheic keratosis called actinic keratosis to form on or around the vulva and vagina, says Dr. Gersh. These patches often appear brown or red and are raised and rough and are easier to feel than to see. Since actinic keratosis can develop into squamous cell cancer, doctors often recommend removing them.
Scaly red patches
Squamous cell carcinoma—the second-most common type of skin cancer that is highly treatable when caught early—can be pigmented and appear as a scaly red patch of skin or thickened, wart-like skin and may form scabs. Squamous cells are a type of skin cell near the skin’s surface and are continuously shed as new cells are formed. “It’s possible for squamous cell carcinoma to occur on vulvar skin, most commonly between the ages of 55 and 75.