Ulcers of the vulvar vaginal area also cause pain. However, it is beyond the scope of this chapter to discuss genital ulcers adequately. One of the most common causes of genital ulcers is herpes simplex virus (HSV), which presents with exquisite pain and a vesicular rash on an erythematous base. HSV lesions are self-limiting, but with rapid identification, lesions can be treated with one of the antivirals, such as acyclovir, to limit the length of the outbreak.

Figure 18 Erosive lichen planus: erosive changes of the introitus. (See color insert p. 5.)

Genital ulcerations can result from other infective organisms such as syphilis and Coxsackie virus. Ulcerations can occur from dermatoses, such as aphthous ulcers, Behcet's syndrome, severe contact dermatitis, pyoderma gangrenosum, or benign familial pemphigus (Hailey-Hailey' s disease). Vulvar ulcerations also can be caused by malignancy, such as with basal cell carcinoma or squamous cell carcinomas of the vulva, and can arise in relation to systemic diseases processes, such as Crohn's disease. Finally, vulvovaginal ulcerations may result from traumatic causes such as immobility, with the development of decubitus ulcers, or from foreign bodies, such as a pessary used to treat pelvic organ prolapse and incontinence.

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