OVERVIEW

What is Acute Vulvar Ulcer?

Acute vulvar ulcer (ulcus vulvae acutum), also known as acute genital ulcer or Lipschütz ulcer, is named after Benjamin Lipschütz, who first described this condition in 1912.

Some cases are associated with acute Epstein-Barr virus (EBV) infection or other viral/bacterial infections, but the exact cause often remains unclear.

Acute vulvar ulcer is non-severe and non-contagious. Though rare and easily overlooked, it primarily affects adolescent girls or young women. Typical features include painful genital ulcers, possibly accompanied by fever and lymphadenopathy. Treatment focuses on symptomatic relief—cleansing, pain management, and preventing secondary infection. The ulcers usually heal spontaneously within 2–6 weeks.

SYMPTOMS

What are the common manifestations of acute vulvar ulcers?

The most common manifestation is the sudden appearance of vulvar ulcers. An ulcer refers to a localized defect and breakdown of the skin or mucous membrane. The ulcers are typically large and deep, with a diameter >1 cm, purplish-red borders, and may have a grayish exudate or black crust at the base. Additionally, the ulcers may appear symmetrically.

Severe pain and/or pain during urination are often present. In most cases, symptoms such as fever, malaise, inguinal lymphadenopathy, and labial edema may also occur.

Where do acute vulvar ulcers commonly occur?

The ulcers primarily develop on the labia minora in women but may extend to the labia majora, perineum, vestibule, lower vagina, and urethra.

Although the condition is called acute vulvar ulcers, men may also develop similar ulcers on the penis, scrotum, or other genital areas. In such cases, they may be referred to as acute genital ulcers or Lipschütz ulcers.

Do acute vulvar ulcers continuously develop new lesions?

No, acute vulvar ulcers do not continuously form new lesions. The condition can resolve on its own, with ulcers typically lasting 2–6 weeks. However, some individuals may experience recurrences.

CAUSES

What are the common causes of acute vulvar ulcers?

In most cases, the exact cause cannot be determined. Some patients may exhibit symptoms related to EB virus infection.

Additionally, it may also be associated with other viral and bacterial infections, including cytomegalovirus, influenza A virus, influenza B virus, mumps virus, Salmonella, Mycoplasma, disseminated Lyme disease, and Group A Streptococcus.

Which groups are more prone to acute vulvar ulcers?

Adolescent girls or young women, with the average age of onset ranging from 12 to 29 years.

Is acute vulvar ulcer contagious?

No, it is not contagious.

Is acute vulvar ulcer hereditary?

No, it is not hereditary.

DIAGNOSIS

How is acute vulvar ulcer diagnosed?

Doctors primarily diagnose it by analyzing the medical history and conducting a physical examination.

Diagnostic clues include: the presence of one or more vulvar ulcers; bilateral ulcers forming "kissing lesions" (symmetrical and able to align); no sexual contact; no immunodeficiency; exclusion of other causes of genital ulcers; sudden onset; and spontaneous resolution within 6 weeks of symptom onset.

What tests are needed to diagnose acute vulvar ulcer?

Testing is not always necessary.

Occasionally, tests may be required to rule out other causes of genital ulcers, depending on the evaluating physician's assessment.

What diseases can acute vulvar ulcer be confused with? How to differentiate them?

Acute vulvar ulcer has many differential diagnoses, including genital herpes, HIV infection, syphilis, Behçet's disease, pyoderma gangrenosum, and pemphigus. Key distinguishing features are as follows:

• Genital herpes: Primarily presents as blisters and superficial erosions, with less severe ulcers. Herpes simplex virus nucleic acid testing can confirm the diagnosis.
• HIV infection: Acute HIV infection may cause painful mucocutaneous ulcers. HIV nucleic acid or antibody testing can confirm the diagnosis.
• Syphilis: Primary syphilis typically presents as a painless chancre, 1–2 cm in diameter, with a hard, raised border. Pathogen testing for syphilis can confirm the diagnosis.
• Behçet's disease: Of unknown cause, it can cause painful genital and oral ulcers. Genital ulcers are deep, painful, and leave scars after healing. Eye and skin lesions may also occur.
• Pyoderma gangrenosum: Begins as tender nodules or pustules, rapidly progressing to ulcers with raised edges. Histopathological examination can aid diagnosis.
• Pemphigus: Main features include recurrent vulvar erosions and blisters. Histopathological examination can aid diagnosis.

TREATMENT

Which department should I visit for acute vulvar ulcers?

Dermatology, gynecology, or obstetrics and gynecology.

Can acute vulvar ulcers heal on their own?

This condition can resolve spontaneously. Ulcers typically last 2–6 weeks and usually leave no scars after healing.

How is acute vulvar ulcer treated?

Since acute vulvar ulcers can heal on their own, treatment mainly focuses on symptom management.

• Reassurance: Don’t worry—this type of ulcer is not a sexually transmitted disease, is non-contagious, and recurrence is rare.

• Local hygiene and wound care: Warm sitz baths can be used to clean the ulcer surface. Alternatively, a handheld shower or spray bottle may also be helpful.

• Pain relief: Topical anesthetics, such as 2% lidocaine solution or 5% ointment, can be used as needed for temporary pain relief. If ulcers involve the urethral opening, severe pain during urination may occur, and applying topical anesthetics before urination can help.

Can patients with acute vulvar ulcers take painkillers?

If topical anesthetics fail to control the pain, oral pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) may be considered.

Do patients with acute vulvar ulcers need hospitalization?

Hospitalization is generally unnecessary. However, it may be required if severe pain or urinary retention occurs.

What are the common side effects of medications for acute vulvar ulcers?

Topical pain relievers rarely cause side effects. Oral painkillers may occasionally lead to rashes, headaches, gastrointestinal ulcers, or bleeding.

Can acute vulvar ulcers be completely cured?

They can mostly be cured, though recurrence may occur in rare cases.

DIET & LIFESTYLE

What should patients with acute vulvar ulcers pay attention to in their diet?

Maintain a normal diet without restrictions; no dietary limitations are necessary.

What should patients with acute vulvar ulcers pay attention to in daily life?

Stay relaxed, reduce stress, and follow the doctor's instructions for basic symptomatic treatment.

Is follow-up examination required for acute vulvar ulcers?

Generally not required. However, if symptoms worsen or persist for more than 6 weeks without improvement, a follow-up evaluation is needed.

Does acute vulvar ulcer affect fertility?

No.

PREVENTION

Can acute vulvar ulcers be prevented? How to prevent them?

There is currently no effective prevention method.

How to prevent recurrence of acute vulvar ulcers?

There is currently no effective way to prevent recurrence.