Vulvar ulcer

Introduction Vulvar ulcers are caused by bacterial or viral stimulation of the skin and mucous membranes of women's genitals, or caused by syphilis, sexually transmitted lymphogranuloma and cancer. The early stage of vulvar ulcer caused by sexually transmitted diseases should effectively control infected skin lesions and track the source of infection. Sexual partners should be treated with or without symptoms. Pay attention to mixed infection with other sexually transmitted diseases, especially if you have HIV infection at the same time. At present, the most effective prevention method is to avoid contact with infectious skin lesions. The condom can reduce the spread of the disease and it is not suitable for sexual life during the infection.

Cause

Causes of vulvar ulcers:

Acute vulvar ulcer

(1) Non-specific vulvitis: ulcers often occur after scratching, and may be accompanied by symptoms such as low fever and fatigue. Local pain is severe, the ulcer is superficial, the number is small, and there is obvious inflammation around.

(2) Herpes virus infection: acute onset, after exposure to herpes simplex virus infection source, there is usually 2 to 7 days of incubation period after fever, discomfort, inguinal lymphadenopathy and herpes. From the beginning, there are multiple herpes, and the herpes is a superficial multiple ulcer with a severe pain. Ulcers often involve the labia minora, especially on the medial side, where more than 50% to 80% of cases involve the vagina, urethra and cervix. Ulcers vary in size, the bottom is grayish yellow, the surrounding margin is slightly elevated, and it is highly congested and edematous. The ulcer often heals naturally within 1 to 2 weeks, but often recurs. Herpes simplex virus involves the vagina, urethra, etc., patients often accompanied by a large number of vaginal discharge, leucorrhea is a transparent slurry, followed by turbid thin pus, and finally a yellow purulent leucorrhea due to bacterial infection, accompanied by urinary symptoms, such as Urgency, difficulty urinating, etc.

(3) Behcet's disease: Acute vulvar ulcers are common in Behcet's disease, namely eye-mouth-genital syndrome. In the past, acute vulvar ulcer was considered to be a benign ulcer of non-contact infection caused by crude bacilli. It is now believed that acute vulvar ulcer is a development stage of Behcet's disease, which may occur simultaneously or sequentially with ocular lesions. Ulcers can occur extensively in various parts of the vulva, and the medial and lateral vaginal and vaginal vestibules are more frequent. The onset is acute and often relapses. It is clinically divided into 3 types, which can exist alone or in combination, with the most severe gangrene.

1 gangrene type: more than first systemic symptoms, such as fever and fatigue. The lesions are red and swollen, the edges of the ulcers are not neat, there is a phenomenon of excavation, and local pain is heavy. A large amount of pus or a yellowish-to-grey black necrotic pseudomembrane is attached to the surface of the ulcer, and the substrate is uneven after removal. The lesion develops rapidly and can cause a defect in the labia minora. The appearance is similar to vulvar cancer, but the edges and base are soft and there is no infiltration.

2 squat type: more common, generally mild symptoms, slow course, more ulcers, shallower, red and swollen around the ulcer, the edges are not neat, there may be digs. It usually heals in a few weeks, but often in the healing phase of the old lesions, new ulcers appear nearby.

3 Miliary type: ulcers, such as needles to rice grains, the number is large, the recovery is fast, and the symptoms are mild.

(4) Sexually transmitted diseases such as syphilis, soft chancre and sexually transmitted lymphogranuloma can cause vulvar ulcers.

1 syphilis: syphilis vulvar ulcers can occur in the first and second phases of syphilis. Ulcer may occur on the surface of syphilis, after 2 to 4 weeks of incubation period after infection with syphilis, the initial syphilis lesion is a hard chancre in the local part of the spiral invasion. It is characterized by painless red inflammatory induration, round, 1~2cm in diameter, shallow ulcer, neat edges, peripheral bulge, smooth sore surface, dark red, serous purulent discharge on the surface, ulcers are mostly single. Located in the size of the labia and labia, it can also be seen in the clitoris, urethra or cervix.

2 soft squat: ulcers are often multiple, females with an average of 4 to 5 ulcers, then ulcers can be planted by themselves, and can form clusters of small ulcers around them, ulcers usually healed in 1 to 2 months. The initial involvement of the inflammatory small papules, surrounded by redness, 1 to 2 days into pustules, formed erosion after rupture, and then expanded to form ulcers, ulcers of various sizes, diameter 1 ~ 20mm edge rough and sloped The boundary is clear, surrounded by redness, the base is soft and deep, covered with gray or yellow necrotic purulent secretions, removes the sputum purulent secretions, revealing a granuloma-like base, which is tender and prone to bleeding.

3 sexually transmitted lymphogranuloma. Start with a single papule and herpes, blisters or pustules, no pain, no infiltration, and then rupture into a smash or shallow ulcer. Ulcers occur in the vestibular, labia minora, vaginal opening and around the urethra. The shape of the lesion is flat and superficial. After several days to half a month, the ulcer is self-healing without scarring.

2. Chronic vulvar ulcer

(1) tuberculosis: vulvar tuberculosis is rare, even secondary to severe lung, gastrointestinal tract, internal reproductive organs, peritoneal or bone tuberculosis, occurs in the labia or vestibular mucosa. The lesion develops slowly, often starting with a limited small nodule, and soon it breaks into a shallow ulcer that is soft and thin. The shape of the ulcer is irregular, the base is uneven, covered with a cheese-like structure, and the lesion is painless, but it may be severely painful after being stimulated or rubbed by urine, and the ulcer may not heal for a long time and may spread to the periphery.

(2) Cancer: Vulvar malignant tumors may manifest as papules, nodules or small ulcers in the early stage, and the lesions are mostly located in the labia majora, clitoris and posterior joints. With or without vulvar white lesions, cancerous ulcers and tuberculous ulcers are difficult to identify with the naked eye. A biopsy is needed to confirm the diagnosis.

an examination

Related inspection

Blood routine genital gynecological routine examination polymerase chain reaction polymerase chain reaction syphilis hemagglutination test

Diagnosis of vulvar ulcers:

1. Non-specific vulvitis After scratching, local pain, may be accompanied by low heat, fatigue, etc., there is obvious inflammation around the ulcer.

2. Herpes virus infection, acute onset, herpes breaks into ulcers, accompanied by fever, inguinal lymphadenopathy and general malaise. The ulcer base is grayish yellow, obviously congestive and edematous, self-healing but often relapse.

3. One stage of the development of Behcet's syndrome may be acute vulvar ulcer, which occurs successively with ocular and oral lesions, and can be divided into gangrene and sputum.

4. Syphilis, soft squat, see sexually transmitted diseases.

5. Vulvar tuberculosis and vulvar cancer can be characterized as chronic ulcers.

Differential diagnosis

Differential diagnosis of vulvar ulcers:

Syphilis: mainly occurs in stage I syphilis, called hard chancre, lesions occur in the genital area, but also in the lips, pharynx, tongue and breasts.

Genital herpes: multiple papules, small blisters or pustules appear in the genital area, and then evolve into erosion, ulcers, itching and pain in the skin lesions. The ulcer usually subsides in about 3-4 weeks, and new damage can be achieved after healing. Occurs or recurs in situ.

Sexually-acquired lymphogranuloma: The primary lesion is a small blisters or papules of 5-6 mm. The symptoms are mild and can form ulcers. It occurs in the vulva and heales after a few days without leaving scars.

Inguinal granuloma: more skin lesions occur in the vulva, the initial skin lesions are hard subcutaneous nodules, and then form a clear line of proliferative granulomatous ulcers, smelly, edge curling up, center beef red, touch It is easy to bleed, has no pain, has pus on the surface of the ulcer, and many small satellite-like ulcers can occur around it.

1. Non-specific vulvitis After scratching, local pain, may be accompanied by low heat, fatigue, etc., there is obvious inflammation around the ulcer.

2. Herpes virus infection, acute onset, herpes breaks into ulcers, accompanied by fever, inguinal lymphadenopathy and general malaise. The ulcer base is grayish yellow, obviously congestive and edematous, self-healing but often relapse.

3. One stage of the development of Behcet's syndrome may be acute vulvar ulcer, which occurs successively with ocular and oral lesions, and can be divided into gangrene and sputum.

4. Syphilis, soft squat, see sexually transmitted diseases.

5. Vulvar tuberculosis and vulvar cancer can be characterized as chronic ulcers.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.