Lipschutz Ulcer

Overview

Lipschutz ulcer is a painful sore that can appear on the outer female genital area, especially the labia (the lips of the vulva). It is also called acute genital ulcer. It is not a sexually transmitted infection (STI). It often happens during or after a viral illness and usually heals with supportive care.

It is uncommon. Many healthcare providers may never see a case, so it can take time to recognise. It is not a sign that you or your child has done something wrong.

It most often affects young women and girls, especially before age 20, but it can affect other people too. It can happen to people who have never been sexually active.

Symptoms

Common symptoms

• One or more painful sores on the vulva, often round or oval with a red edge and a pale or grey centre
• Pain or burning when passing urine
• Fever or flu-like feeling
• Swollen tender glands in the groin
• Vaginal discharge in some cases
• Pain during walking, sitting, or sex

Symptoms in children

• It is rare in children but can occur, mainly in girls.
• A child may cry or complain of pain when passing urine, refuse to use the toilet, or have fever.
• Seek same-day medical advice if a child cannot pass urine, has a high fever, or has severe genital pain.

Symptoms in older adults

• It is rare after menopause.
• A new genital ulcer in an older adult should be checked promptly because other causes are more likely at this age.

Causes

Main causes

• Often linked to a recent infection, especially Epstein-Barr virus (EBV), the virus that causes glandular fever.
• Sometimes linked to other infections, such as mycoplasma or other viruses and bacteria.
• Sometimes no clear cause is found. It may be an immune reaction that causes inflammation and sores.
• It is not caused by sexual activity and is not classed as a sexually transmitted infection.

Risk factors

• Being a young woman or girl, especially under age 20
• A recent viral illness or glandular fever
• Changes in the immune system
• Having never had sex does not rule it out and is common in reported cases

When to see a doctor

See a doctor urgently if:

• You cannot pass urine or passing urine is extremely painful
• You have a high fever or feel very unwell
• The ulcer is getting bigger, spreading, or looks infected
• You have severe pain that is not controlled with simple pain relief

Book a routine appointment if:

• You notice any new genital ulcer for the first time
• Ulcers keep coming back
• An ulcer is not healing after a few weeks
• You want to be checked for STIs or other causes of genital ulcers
• You feel worried or embarrassed and want advice

Diagnosis

A healthcare provider will ask about your symptoms, recent illnesses, and medical history. They will look at the sores. They may take a swab from the ulcer and arrange blood tests to check for infections such as EBV and to rule out STIs. The diagnosis is usually made from the pattern of symptoms and test results.

Tests that may be done

• A swab from the ulcer to check for infections
• Blood tests for Epstein-Barr virus and other infections
• Urine tests
• Tests for sexually transmitted infections, even if you are not sexually active, because some can cause similar sores
• A small biopsy (tissue sample) if the diagnosis is unclear or the ulcer does not heal

What to expect at your appointment

The examination can feel uncomfortable or embarrassing. You can ask for a chaperone, a female clinician if available, and to stop at any time. The tests are usually quick. Results may take a few days. Your provider will explain what they find and what to do next.

Treatment

Treatment focuses on easing pain, helping the sores heal, and treating any infection that is found. Most people do not need surgery. Your healthcare provider will advise what is safe for you.

Self-care at home

• Take simple pain relief as advised by your pharmacist or healthcare provider
• Use cool compresses or a shallow warm bath to soothe the area and make passing urine less painful
• Wear loose cotton underwear and avoid tight clothing
• Keep the area clean with plain water and avoid scented soaps, wipes, or douches
• Drink plenty of fluids to keep urine less concentrated
• Avoid scratching or rubbing the sores
• Rest and give your body time to heal

Medical treatments

Your healthcare provider may suggest pain relief, soothing creams or gels, and treatment for any infection that is found. In severe or recurrent cases, they may refer you to a specialist. Antibiotics are only used if a bacterial infection is confirmed. Do not use leftover medicines or share medicines with others.

When is surgery considered?

Surgery is not usually needed for Lipschutz ulcers. In rare cases, a specialist may advise a procedure if there is a complication such as scarring or ongoing problems.

Living with this condition

The sores can be painful for a week or two, and some people feel tired or feverish. Plan rest, use pain relief as advised, and avoid activities that rub or irritate the area. Most people start to feel better within a few days to weeks.

Lifestyle tips

• Choose loose, soft clothing and cotton underwear
• Avoid scented products, harsh soaps, and vaginal douches
• Do not scratch or pick at the sores
• Wash your hands before and after touching the area
• Use a gentle laundry detergent and rinse underwear well
• Ask for help with childcare, work, or daily tasks if you feel unwell

Diet and exercise

There is no special diet for Lipschutz ulcers. Eat and drink normally, and drink enough fluids. Gentle activity is fine if you feel able. Rest when you feel tired or feverish. Avoid intense exercise that rubs the genital area until the sores are less painful.

Mental health and emotional wellbeing

Genital ulcers can feel embarrassing, worrying, or isolating. It is normal to feel upset. You do not have to cope alone. If you feel overwhelmed, anxious, or have thoughts of harming yourself, contact your local crisis support service or emergency services right away.

Prevention

There is no sure way to prevent Lipschutz ulcers. Good general health, treating infections promptly, and getting any genital ulcer checked early can help you get the right care. Practising safer sex helps protect against STIs, although it does not specifically prevent Lipschutz ulcers.

Vaccines

There is no vaccine specifically for Lipschutz ulcers. Keep up with routine vaccines as advised by your local health service.

Screening programmes

There is no routine screening test for Lipschutz ulcers. See a healthcare provider if you notice any genital ulcer or unusual pain.

Complications

If left untreated

• Ongoing pain and difficulty passing urine
• Dehydration if pain stops you drinking or passing urine
• A secondary bacterial infection of the sores
• Scarring or sticking together of the labia in rare cases
• Recurrence of ulcers in some people

Long-term outlook

Most Lipschutz ulcers heal with supportive care and do not cause lasting problems. Some people get them more than once, but they can be managed. Because the condition is not an STI, it does not mean you or your child has an infection from sexual contact. Seeing a healthcare provider helps rule out other causes and get the right support.

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