Not all vulval ulcers are herpes: stress (aphthous) ulcers
Aphthous ulceration (also known as stress ulcers) in the mouth are very common and most people get them at some stage. However it is not so well understood that aphthous ulcers may involve the vulva where they may become a significant problem, not only because they can be very painful but because they are often mistaken for herpes simplex (genital herpes) and if you don't actually have genital herpes this can be a pretty devastating mistake.
Aphthous ulcers are classified as minor or major. Minor aphthous ulcers are small (2-4mm), superficial and heal quickly, within 7-10 days. Major lesions are large, often as big as 10mm, deep, severely painful and sometimes very slow to heal, occasionally taking many months.
Aphthous ulceration is a harmless condition. A tendency to aphthae runs in families. The cause is still unknown.
What are the features of aphthous ulcers
Aphthae are found in all age groups and although less common in children than adults, do occur before puberty.
The typical aphthous ulcer is round to oval with a yellow, base and a red rim. The onset of the lesion is sudden and associated with significant pain and tenderness.In some cases pain is so severe that you can’t to walk or urinate.
Aphthous ulcers may be located on any part of the opening of the vagina and may be single or multiple. Even when large, they usually heal without scarring.
Attacks of aphthous ulcers are often recurrent ranging from infrequent to very frequent, to the point where they are almost constant.
Patients with genital aphthous ulcers frequently have a history of oral ulcers.
A subtype of major aphthosis, which has been also called Sutton’s ulcer, is of particular importance. It is most often seen in pre-adolescent or adolescent girls and if often preceded by fever. Patients experience a sudden onset of very painful, dramatic, vulval ulceration which is frightening.
How are aphthous ulcers treated?
The most important part of management is initial, accurate diagnosis. Herpes simplex should always be ruled out with a swab test because the treatment of herpes and aphthous ulcers is completely different.
Pain relievers are very important. If you are having trouble urinating, running a warm bath and urinating in the bath can help, but if you just can’t go to the toilet, you need to go to a hospital emergency department.
Cortisone is the best treatment for acute ulcers. If they are severe this is given by mouth. If they are minor it can be applied as an ointment.
If you are getting frequent ulcers, preventative treatment is available. The safest is the antibiotic doxycycline. This is not used because aphthous ulcers are an infection and in fact we are not sure how it works. Doxycycline has to be prescribed by a doctor.
If you think you might be getting aphthous ulcers see your doctor. Although oral aphthous ulcers are very common and every general practitioner knows what they are, the genital ones are not nearly so common. If your GP isn't sure, direct them to this website!