Premenarchal vulvar ulceration: is chronic irritation a causative factor?

OBJECTIVE: To study the common features of the young girls with vulvar ulcerations, and to help guide physicians caring for girls with this unusual condition.
METHODS: In this retrospective study, ten patients who developed vulvar ulcerations and denied any kind of sexual contact or sexual abuse were identified. Patient information was collated from detailed history, physical, and laboratory examinations including age, menarchal status, type of clothing worn, whether history of oral aphthosis or previous vulvar ulcers had occurred, symptoms at the time of presentation, description of ulcer, laboratory studies including serologies, blood count, erythrocyte sedimentation rate, C-reactive protein, and biopsy results.
RESULTS: Despite multiple evaluations, no patient had a specific medical cause identified to account for their vulvar ulcerations. None were diagnosed with Behcet's syndrome. Seven had bilateral vulvar ulcerations, which we attribute to the practice of wearing tightly fitted pants or polyester underwear frequently. No recurrences were documented in 6 months follow-up.
CONCLUSION: Girls with vulvar ulcerations who have deny being sexually active should be thoroughly evaluated for infections, Behcet's disease, and other health problems, but, in addition, should be questioned about use of tight-fitting clothing in the perineal area. We hypothesize that chronic irritation because of tight clothing may play a role in causing vulvar ulcerations in this setting.