Unusual vulvar ulcerations in young adolescent females

Study objective To review a series of young female patients who presented to the Cincinnati Childrenʹs Hospital Medical Center in Cincinnati, Ohio, from July of 1996 to November of 2001 with new, unexplained vulvar ulcerations, in order to elucidate common factors. Design Retrospective case series. Setting Cincinnati Childrenʹs Hospital Medical Center and its satellite offices. Participants Female patients who have never been sexually active or abused who presented with the diagnosis of vulvar ulcerations. Interventions None. Main outcome measures Description of clinical features. Results Nine patients who developed vulvar ulcerations and denied sexual contact or sexual abuse were identified. Eight of nine were premenarchal. All nine had negative Herpes Simplex Virus (HSV) cultures from the lesions, and three had negative HSV serology. Negative Epstein Barr virus (EBV) tests were documented in six patients. Lesions were recurrent in three patients. The diagnosis of Behcetʹs disease was considered in three patients. The remaining six patients had systemic complaints consistent with a viral syndrome at the time of the vulvar ulcerations, but no definite etiology could be documented. Conclusion The rare finding of a vulvar ulcer in a sexually inexperienced patient can result in a diagnostic dilemma in the absence of signs of systemic illness such as Crohnʹs disease, Behcetʹs syndrome or EBV infection. These ulcers could be a local manifestation of a non-sexually transmitted systemic viral infection that has yet to be identified. The occurrence in premenarchal females suggests the possibility of mediating hormonal factors.