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Perineal ulcer

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Perineal ulcer refers to the loss or exfoliation of the normal epithelium of the skin mucosa in the anus and genital area. Because the cause of genital ulcers is complex and diverse, it usually represents a type of disease including a variety of skin diseases, sexually transmitted diseases, and the like.

Cause

Cause

1. The genital area can also occur in the lips, pharynx, tongue and breast. It is often a painless ulcer with a diameter of 1~2cm. It touches the base cartilage-like hardness, the surface of the ulcer is clean, and there is a small amount of exudate. The number is usually single or 2~3. The ulcer can disappear naturally within 3~8 weeks without treatment. After the healing, there is no trace or only mild atrophy and pigmentation. Genital herpes: first in the genital area Multiple papules, small blisters or pustules appear, which then evolve into erosions and ulcers. There are itching and pain in the skin lesions. The ulcer usually resolves in about 3~4 weeks. After the healing, new lesions may occur or relapse in situ. Sexually transmitted diseases Lymphocytic granuloma: Primary lesions are small blisters or papules of 5~6mm. The symptoms are mild and can form ulcers. It occurs in the vulva. The lesions are often single, sometimes multiple, with no obvious symptoms. Self-healing in the future, no 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 High 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.

2. Skin diseases: The following skin diseases can also occur in the vulvar ulcers. Fixed drug eruptions: skin lesions can be painful erythema, blisters, erosions or ulcers, often single or multiple. There is a clear history of medication, after each dose Occurred in the same site, more common in the skin mucosa junctions such as lips, glans, anus, etc., can also occur similar lesions in other parts of the body. Behcet's syndrome: also known as eye-mouth genital syndrome. In addition to this disease Oral ulcers, eye damage, skin symptoms, joint symptoms, vasculitis and neurological diseases, genital ulcers are also one of the characteristic symptoms. Often painful ulcers, early pain is more obvious, ulcers healed about 1 to 3 weeks Scars can be left, and the condition is easy to recur, for several years or decades. Acute female genital ulcers occur mostly in young women. The onset is sudden and begins to be a genital ulcer, which occurs in the medial and vestibular mucosa of the large and small labia. The ulcer varies from rice to 1~2cm, and the ulcer area is large. The lesion is deep, the surface is covered with necrotic membrane-like substances, and the local pain is obvious. The course of the disease is generally 3 to 4 weeks, and scars are left after healing. Acute eczema can occur in the scrotum, female genitals, anus and other parts. The rash is the most dense miliary small papules, herpes, or small blisters. The base is flushed and consciously itchy. It is easy to form small erosion surface due to factors such as scratching or Ulcers, if not treated in time, can easily evolve into subacute, chronic eczema or secondary infections.

3. Non-specific damage: the genital skin mucosa can also be ulcerated under the action of scratching, anal sex, masturbation or other external forces. Such ulcers are generally superficial and have obvious pain. If there is no secondary infection, it will heal in a week. Because of the many causes of genital ulcers, it should be carefully observed from the aspects of appearance, medical history, disease course and disease progression, combined with smear, culture, hematology and general condition examination of ulcer surface secretions. For the long-term cure of vulva For ulcers, the living tissue should be taken for pathological examination at the lesion to confirm the diagnosis. After suffering from the genital ulcer, the patient should go to the hospital in time to find out the cause as soon as possible, and carry out targeted treatment under the guidance of a doctor. Self-righteous use of drugs, so as not to bring difficulties to diagnosis and treatment, delay the disease, causing irreparable consequences. At the same time should minimize the friction of the skin lesions, keep the vulva clean and dry, every time after cleaning the vulva, should dry the water. Some patients with severe symptoms should also rest in bed and change their medication regularly to facilitate the healing of skin lesions.

Examine

an examination

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Vulvar ulcers can be characterized by acute vulvar ulcers and chronic vulvar ulcers. Among them, acute vulvar ulcers have the following manifestations:

(1) Non-specific vulvitis. The condition is milder, and more ulcers appear after scratching. Ulcers are generally superficial, but the pain is more severe, and sometimes there are systemic symptoms, such as low heat, fatigue and so on.

(2) Herpes virus infection. This situation started quickly. At the beginning of the disease, there were multiple pityriasis. After the pityriasis collapsed, it became a superficial ulcer. The ulcers were of different sizes. The base was yellowish gray, the marginal tissue was slightly higher, and there was obvious congestion. , edema, severe pain.

(3) Behcet's disease. Also called eye genital syndrome, is a common cause of acute vulvar ulcers. Acute vulvar ulcer is a developmental stage of Behcet's disease, which can occur simultaneously or sequentially with eye and oral lesions. The onset is urgent and often recurs. Chronic vulvar ulcers can be found in tuberculosis and cancer. Vulvar tuberculosis is rare, occasionally secondary to severe lung, gastrointestinal tract, internal reproductive organs, peritoneal or bone tuberculosis. Occurs in the labia or vestibular aponeurosis. The lesion develops slowly. At the beginning, it is usually a limited small nodule, and soon it breaks into a shallow ulcer with a soft edge. The shape of the ulcer is irregular, the base is uneven, and it is covered with cheese-like dirt. The lesion is usually painless, but it can be severely painful after being stimulated or rubbed by urine.

Diagnosis

Differential diagnosis

Female genital perineum appears red crusting plaque: female genital perineum appears red crusting plaque female Reiter syndrome symptoms, female Reiter syndrome is rare, female genital skin and mucosal rash is less common. Reiter syndrome is characterized by aseptic urethritis, conjunctivitis and multiple arthritis. It can be found in skin and mucous membranes of other skin and other organs. It often has fever before onset and is more common in adult males. The formation of the perineal fistula or sinus: it is caused by localized enteritis. Occurred in the genital area of the vulva is a multiple ulcer, which is a chronic inflammatory disease of the gastrointestinal tract with unknown etiology. It is characterized by segmental specific lesions from the oral cavity to the digestive tract of the anus. Clinically, abdominal pain, diarrhea, abdominal mass, fistula formation and intestinal obstruction are characterized by fever, anemia, nutritional disorders and extraintestinal manifestations of joints, skin, eyes, oral mucosa, and liver. The size of the labia majora or anus is different, soft and no tenderness mass: the abdominal organs and the fascia at the bottom of the pelvic cavity are separated from the perineum, which is called vaginal discharge. The perineum is the connection of the ischial nodules on both sides of the soft tissue structure of the closed pelvic outlet below the basin. It will be divided into two triangles: the front is called the urogenital triangle, which is closed for the urogenital tract, the male has the urethra, the female has the urethra and the vagina. Pass; the rear is called the anus triangle, closed for the pot, and the rectum passes. There is a weak point between the pelvic floor appendix and the pubic tail muscle, and most of the ticks pass through this gap. Perineal fistula is a rare abdominal hernia. It occurs mostly in women over 40 years of age. It is related to the deeper rectal fossa of the female than the male and the multiple muscles of the perineal muscle.