The management of EBV-associated vulvar ulcers includes accurate diagnosis, reassurance, and symptomatic treatment for pain. Perhaps most important is distinguishing EBV-associated vulvar ulcers from other causes of vulvar ulceration. The acute onset and painful nature of this condition can mimic many other conditions, including herpes simplex infection, as well as a number of other sexually transmitted diseases, such as syphilis, chancroid, granuloma inguinale, and lymphogranuloma venereum, and other conditions such as trauma (either accidental or nonaccidental), lichen planus, lichen sclerosus, inflammatory bowel disease, and Behçet syndrome3(Figure 2). Knowledge of EBV as a potential cause of vulvar ulcers is important in avoiding unwarranted accusations of sexual activity or abuse. Recognizing vulvar ulcers, particularly in the context of a non–sexually active teen or preteen, should heighten suspicion for acute EBV infection as a potential cause and prompt serologic evaluation for EBV infection.