Genital ulcers from non-sexually-transmissible viral sources

It’s possible to get vulvar ulcers from viruses that are not sexually transmitted (i.e. herpes simplex (HSV). These ulcers are called Lipschutz ulcers or vulvar aphthae or aphthosis, aphthous meaning ulcer. They could also be referred to as reactive non-sexually related acute genital ulcers (RNSRAGU).

Symptoms of viral vulvar ulcers

  • Ulcers – shallow, well-defined
  • Swollen lymph nodes
  • Affect labia minora (but could extend)
  • Quick onset (acute)
  • Painful
  • Often affect young women and adolescents
  • Flu-like symptoms – fever, tiredness, malaise, headache
  • Possible link with Epstein-Barr (EBV), cytomegalovirus (CMV), influenza A, influenza B

A study on young girls with vulvar ulcers

A 2006 study on girls between the ages of 10 and 19 years looked into vulvar ulcers from non-sexual causes. Five of the girls were premenarchal. Nineteen of the subjects reported fever, malaise, and headache. The ulcers were found to be about 1cm in diameter (with the range being from 0.3 to 5cm), all on the inside of the labia minora (medial side).

The girls were tested for EBV, of which 10 were found to have been infected previously, two had an acute infection at the time of the study, one was indeterminate, and seven were negative. Two subjects had possible acute CMV infection.

The pain lasted from between six and 30 days, with 75 per cent healed by 21 days. In the follow-up of 19 patients, seven had recurrent ulcers between two and 16 months after the original episode, and 10 had ulcers in their mouths.

Young girls presenting with vulvar ulcers – it’s tricky

Treating young girls with vulvar ulcers means an immediate evaluation for sexual activity or sexual abuse, since that is the most common cause of vulvar ulcers (HSV). This can be quite emotional, and needs to be dealt with sensitively.


  • Genital ulcers: it is not always simplex … 2014, G Haidari, E MacMahon, CYW Tong and JA, White The International Journal of HIV and AIDS, 2015, Vol. 26(1) 72–73
  • Huppert, JS, Gerber, MA, Deitch, HR, Mortensen, JE, Staat, MA & Adams Hillard, PJ 2006, ‘Vulvar Ulcers in Young Females: A Manifestation of Aphthosis’, Journal of Pediatric and Adolescent Gynecology, vol. 19, no. 3, pp. 195–204.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)