VULVAL ULCERS

Vulval ulcers are predominantly due to sexually transmitted diseases. Rarely, it may be due to nonspecific causes. Malignant ulcer is also rare.

Other systemic diseases with vulvar manifestation are mentioned below: -

Crohn’s disease: It affects primarily the intestine and may involve the vulva in late stage of the disease in about 25 percent of cases. The ulcer looks granulomatous like knife cuts in the skin.

BEHCET’S DISEASE:

This is a rare chronic inflammatory disease characterized by recurrent oral and genital ulcers (cervix, vulva or vagina) with ocular ulcer (anterior uveitis). It may be the manifestation of an underlying autoimmune process. Monoarticular arthritis may also be associated. The vulval ulceration may be extensive and leaving behind dense scar after healing.

There is no specific treatment. Topical and systemic corticosteroids are used for relief of the symptoms. Systemic immunosuppressants are found useful.

LIPSCHUTZ ULCER:

The lesion affects mainly the labia minora and introitus. In acute state, there may be constitutional upset with lymphadenopathy. The causative agent may be Epstein-Barr virus.

Vulval Ulcer: Leukemia—Rarely may cause nodular infiltration and ulceration of the vulva.

Dermatological disorders: Disseminated lupus erythematosus may cause recurrent ulcerations of the vulva and mucous membrane of the mouth and vagina.

VULVAL MANIFESTATIONS OF SYSTEMIC DISEASES: -

1. Dermatologic disorders:

(i) Contact dermatitis— due to agents that may be locally irritant.

(ii) Psoriasis.

(iii) Ulceration due to disseminated lupus erythematosus.

2. Vulval ulceration or deposits due to leukemia.
3. Acanthosis nigricans—hyperpigmented lesion of the vulva. It may be associated with glucose intolerance (insulin resistance), chronic anovulation and androgen excess.
4. Chronic vulvovaginal candidiasis—Due to diabetes, obesity and antibiotic use. Correction of basic pathology and prolonged topical antifungal therapy clears the infection.
5. Behcet’s syndrome.
6. Sjogren’s syndrome: Patients present with vaginal dryness and pain associated with ocular or oral dryness. There may be arthralgia, myalgia (presence of auto-antibodies).

VULVAL CYSTS: -

Bartholin’s cyst.

Sebaceous cyst—These are usually multiple and are formed by accumulation of the sebaceous material due to occlusion of the ducts. These are located in the labia majora. If infected, treatment is done by antibiotics and surgical drainage.

Cyst of the canal of Nuck—Part of the processus vaginalis, which accompanied the round ligament and got obliterated prior to birth may persist to form a cyst. It invariably occupies the anterior part of the labium majus.

INGUINOLABIAL HERNIA: -

When the entire processus vaginalis remains patent, there may be herniation of the abdominal contents along the tract. The hernia may be limited to the inguinal canal or may extend up to the anterior part of the labium majus. The contents of the sac may be intestine or omentum. The swelling is reducible and impulse on straining can be elicited. One should be conscious of the entity as casual surgical incision on labial swelling may cause inadvertent injury to the gut.

HOMOEOPATHIC MANAGEMENT OF VULVAL ULCERS: -

1. Sepia:- helpful in cases where pimples appear all around the vulva. It is attended with severe itching of the vulva. Useful for painless fluid filled eruptions on the outer parts of the vulva. The other indication is red, swollen, inner labia with itchy eruptions.
2. Nat mur:- well indicated in cases where sores occur from genital herpes infection. There is soreness in vagina alongwith itching. During intercourse there is a burning sensation. Soreness and burning after urination.
3. Thuja:- indicated where there are warts around the vulva. They are painful to touch and may bleed. Valuable for treating ulcers on the inner surface of vulva and labia majora.
4. Graphites:- helpful where there are vesicles on the vulva. The vesicles are itchy. Smarting sensation and pain may also be felt in the pimples.
5. Nit acid: - works well in cases of vulval inflammation. Vaginal discharge can be watery, stringy, green or brown in colour. It has an offensive smell.