Identifying Vulvar Ulcers
A vulvar ulcer presents as a break in the skin or mucous membrane on the vulva, which encompasses the external female genitalia. This lesion can manifest as a sore, open wound, or erosion. While a vulvar ulcer itself is a physical symptom, it does not represent a specific disease on its own. Instead, it serves as an indicator of various underlying health conditions, necessitating further medical evaluation.
Vulvar ulcers vary significantly in size, from a pinpoint to several centimeters in diameter. Their shapes might be round, oval, or irregular, with edges that are either well-defined or diffused. The color of an ulcer can also differ, often appearing red, white, or gray, sometimes with a yellowish or purulent base.
These lesions can be superficial erosions or deeper excavations within the tissue. An individual might develop a single ulcer or multiple lesions scattered across the vulva. Common locations include the labia majora, labia minora, clitoral hood, or the perineum. Some vulvar ulcers can be intensely painful, while others might be entirely painless, depending on their origin.
What Causes Vulvar Ulcers
Vulvar ulcers stem from a diverse range of underlying conditions, broadly categorized into infectious, inflammatory, traumatic, and, rarely, malignant causes. Infectious agents, especially sexually transmitted infections (STIs), are common causes. Herpes Simplex Virus (HSV) type 2, and less commonly type 1, causes multiple, small, painful blisters that quickly rupture into ulcers. Syphilis, caused by the bacterium Treponema pallidum, presents as a single, painless, firm ulcer known as a chancre.
Other bacterial infections include Chancroid, caused by Haemophilus ducreyi, which produces painful, ragged-edged ulcers. Granuloma Inguinale, or donovanosis, results from Klebsiella granulomatis and causes progressive, painless, beefy-red lesions. Lymphogranuloma Venereum, caused by specific strains of Chlamydia trachomatis, may initially present as a small, often unnoticed ulcer before leading to swollen lymph nodes.
Beyond infections, non-infectious inflammatory conditions also cause vulvar ulcers. Behçet’s disease, a systemic inflammatory disorder, causes recurrent, painful aphthous-like ulcers on the vulva, similar to canker sores in the mouth. Inflammatory bowel diseases like Crohn’s disease can lead to deep, linear ulcers in the genital area due to chronic inflammation. Certain dermatologic conditions, such as lichen planus, may also result in erosions or ulcers on the vulvar skin.
Physical injury or irritation can also induce vulvar ulcers. This includes trauma from sexual activity, tight clothing, or prolonged friction. Exposure to certain chemical irritants, such as harsh soaps or feminine hygiene products, can cause contact dermatitis that progresses to ulceration. In rare instances, a persistent or unusual vulvar ulcer may signal a malignancy, such as squamous cell carcinoma of the vulva, emphasizing the importance of timely medical review.
Other Signs to Observe
A vulvar ulcer is often accompanied by other localized or systemic symptoms. Pain is a common companion, ranging from mild discomfort to severe, debilitating pain, especially during walking, urination, or sexual activity. Itching or a burning sensation around the ulcerated area can also be present, sometimes preceding the lesion’s appearance. Swelling and redness of the surrounding vulvar tissue are also frequently observed.
Abnormal vaginal discharge or discharge directly from the ulcer itself may occur, varying in color, consistency, and odor depending on the underlying cause. Dysuria (pain or discomfort during urination) may occur, particularly if the ulcer is near the urethra.
General symptoms that can accompany vulvar ulcers include fever, chills, and malaise. Swollen and tender lymph nodes, particularly in the groin, are also a common systemic response, indicating the body’s immune reaction to an infection or inflammation.
Medical Diagnosis and Management
Diagnosis typically begins with a thorough medical history and physical examination. Healthcare professionals will inquire about the ulcer’s onset, any associated symptoms, sexual history, and overall health. A visual inspection of the vulva and surrounding areas helps characterize the ulcer’s appearance, size, and location.
Laboratory tests are often necessary to identify the specific cause. Swabs or scrapings from the ulcer’s surface can be collected for viral cultures, polymerase chain reaction (PCR) tests for viruses like HSV, or bacterial cultures to detect organisms such as Haemophilus ducreyi. Blood tests are frequently used to screen for systemic infections like syphilis. If the cause is unclear, or if the ulcer is persistent, atypical, or suspected to be malignant, a biopsy may be performed. This involves taking a small tissue sample for microscopic examination.
Management of vulvar ulcers is directly dependent on the identified cause. If the ulcer is due to HSV, antiviral medications such as acyclovir, valacyclovir, or famciclovir can help reduce the duration and severity of outbreaks. Bacterial infections like syphilis or chancroid are treated with specific antibiotics. For inflammatory conditions such as Behçet’s disease or lichen planus, anti-inflammatory medications or immunosuppressants may be prescribed to control the underlying immune response. Pain management strategies, including topical anesthetics or oral pain relievers, are also often used to alleviate discomfort regardless of the cause.
When to Consult a Healthcare Professional
Seek medical attention promptly for any new, unexplained, or persistent vulvar ulcer. Early diagnosis and treatment are important for managing the underlying condition and preventing potential complications. Consultation is particularly advised if the ulcer is accompanied by significant pain, fever, swollen lymph nodes in the groin, or unusual vaginal discharge. If there is any concern about possible exposure to sexually transmitted infections, a medical evaluation is also recommended.