A vulvar ulcer is an open sore or lesion on the vulva, the external female genitalia (including the labia, clitoris, and the opening of the vagina and urethra). These lesions represent a break in the skin or mucous membrane, exposing the underlying tissue. Vulvar ulcers are caused by a wide range of conditions, spanning from common infections to inflammatory disorders. They often cause discomfort and require prompt medical evaluation to determine the specific cause and appropriate management.
Physical Characteristics and Appearance
An ulcer is defined as a full-thickness loss of the epidermis and at least a portion of the dermis, distinguishing it from a superficial erosion. Vulvar ulcers may initially present as small bumps or rashes that subsequently open into sores. The visual characteristics of the lesion, such as size, depth, and margin, offer important clues to the underlying cause.
Ulcers vary widely; some are shallow and multiple, often forming from ruptured blisters, while others may be solitary, deep, and firm. The margins can be smooth, jagged, or raised, and the base often has a distinct color, such as gray-yellow or red. For example, Herpes Simplex Virus (HSV) ulcers typically form multiple painful, shallow sores. Conversely, the classic sore of primary syphilis is often a single, painless, firm ulcer with a raised border.
Understanding the Primary Causes
Vulvar ulcers are broadly categorized into infectious and non-infectious origins. Infectious causes, particularly sexually transmitted infections (STIs), are the most common etiology in sexually active individuals.
The Herpes Simplex Virus (HSV), typically type 2, is the leading cause of painful vulvar ulcers, presenting with clusters of small, shallow lesions. Other significant infectious agents include the bacterium Treponema pallidum, which causes syphilis (a single, painless sore called a chancre), and the bacteria Haemophilus ducreyi, which causes chancroid (painful sores with irregular edges). Less common STIs, such as Lymphogranuloma Venereum and Granuloma Inguinale, are also potential infectious causes.
Non-infectious etiologies stem from inflammatory conditions, autoimmune disorders, or physical trauma. Inflammatory diseases like Behçet’s disease cause intensely painful, “punched-out” ulcers, often recurring and sometimes associated with oral ulcers. Other autoimmune conditions, such as erosive Lichen Planus and Crohn’s disease, can also manifest as vulvar ulcers.
Physical or chemical trauma results from friction, scratching, or irritation from hygiene products. Acute vulvar ulcers (Lipschütz ulcers) are a specific, non-sexually acquired type characterized by a sudden onset of painful sores, often following a systemic illness like Epstein-Barr virus. These ulcers resolve spontaneously and are managed symptomatically.
Recognizing Accompanying Symptoms
Vulvar ulcers are frequently accompanied by other symptoms that help guide the diagnostic process. Pain is a common complaint, though its severity varies significantly; ulcers from herpes or chancroid are typically very painful, while a syphilitic chancre is often painless.
A burning sensation during urination, known as dysuria, may occur due to the ulcer’s location near the urethra or an underlying infection. Other local symptoms include itching, unusual vaginal discharge, or fluid leaking from the lesion.
Systemic symptoms often accompany infectious or inflammatory causes, including fever, general malaise, and fatigue. The presence of swollen lymph nodes in the groin (inguinal lymphadenopathy) is another important sign, commonly indicating an underlying infection. This combination of the ulcer’s characteristics and additional symptoms helps narrow the differential diagnosis.
Seeking Medical Evaluation and Management
Any unexplained or persistent vulvar sore requires prompt medical evaluation to determine the exact cause and initiate treatment. The diagnostic process begins with a detailed history, including recent sexual activity, and a thorough physical examination to assess the ulcer’s specific features. Based on this assessment, a healthcare provider will typically order laboratory tests.
Diagnostic Testing
Diagnostic tests often include swabbing the ulcer surface for viral culture or polymerase chain reaction (PCR) testing, particularly for HSV. Blood tests are routinely used to screen for systemic infections like syphilis and HIV. In complex or persistent cases, or when non-infectious causes are suspected, a small tissue sample (biopsy) may be taken from the ulcer edge for microscopic examination.
Treatment Approaches
Management depends entirely on the identified underlying cause. If the ulcer is due to a bacterial STI like syphilis, a course of antibiotics will be prescribed. For viral causes like HSV, antiviral medications help reduce the duration and severity of the outbreak. Inflammatory conditions may be treated with topical corticosteroids or, in systemic cases like Behçet’s disease, with immunosuppressive therapy. General management also includes pain relief with oral analgesics and maintaining good hygiene to prevent secondary infection.