Vulval ulcers: review.

The vulval ulcers that are seen in obstetrics and gynaecological practice in South Africa are most commonly caused by sexually transmitted diseases, especially herpes simplex infection. These ulcers have become more common due to the Human immunodeficiency virus (HIV) epidemic, and are also responsible for increased transmission of HIV, due to mucosal interruption. There are many other rarer causes of vulval ulcers, especially in young women, who may have aphthous ulcers of the vulva, and in older women, where malignancy should be excluded. Vulval ulcers do not always have an appearance that is characteristic of their cause, so there should be a low threshold for biopsy of any abnormal vulval skin.