Lipschütz Ulcer

What is a Lipschütz ulcer?

A Lipschütz ulcer is a rare type of genital ulcer. Unlike other types of genital ulcers, you don’t get Lipschütz ulcers through sexual contact. It causes one or many painful ulcers on your vulva, specifically one or both labia minor (inner vaginal lips). You can also get them on your labia majora (outer lips), at your vaginal opening or on your urethra. Other than the ulcer, symptoms include fever, fatigue and other feelings of discomfort. 

Other names for Lipschütz ulcers are non-sexually acquired genital ulcerations and ulcus vulvae acutum. They get their name from Benjamin Lipschütz, the physician who first described the ulcer.

They’re self-healing and typically resolve within six weeks. But healthcare providers can help you manage painful and uncomfortable symptoms.

How rare are Lipschütz ulcers?

Researchers aren’t entirely sure how common they are, but they know they’re rare. They do know that Lipschütz ulcers mainly affect people assigned female at birth (AFAB) who are:

• Under 20 years old. One study found the average age was closer to 15 years old.
• Not sexually active. This generally means you haven’t had oral, anal or vaginal sex in three months or longer.

There have only been a few cases of a person assigned male at birth (AMAB) getting a Lipschütz ulcer. In these cases, the ulcer appears on your scrotum.

What are the symptoms of a Lipschütz ulcer?

The main symptom of a Lipschütz ulcer is a large, painful and deep ulcer on the surface of your labia (although it can occur anywhere on your vulva). The ulcer typically develops quickly and suddenly.

It causes you to feel unwell like you may feel when you have mononucleosis (mono) or the flu.

You may experience symptoms like:

• Fever.
• Body ache and joint pain.
• Fatigue.
• Swollen lymph nodes in your neck and armpits.
• Sore throat or swollen tonsils. 
• Cough or chest congestion.
• Painful urination (dysuria).

If you have these symptoms, contact your healthcare provider for an official diagnosis.

What does a Lipschütz ulcer look like?

A Lipschütz ulcer typically has the following characteristics:

• Round and less than 1 centimeter in diameter.
• Appears on the vulva, most often on the labia minora (smaller/inner vaginal lips).
• Has a distinct center that contains dead or damaged tissue (necrosis). This makes the center of the ulcer appear gray or black. If a crust forms in the center, it also appears gray or black.
• The border of the ulcer is typically reddish purple. It can sometimes appear swollen.
• There’s a clear separation between the center and border.

People often develop two ulcers that are bilaterally symmetrical (“kissing lesions”). This means you develop an ulcer on the right and left labia where the ulcers rub together.

What causes a Lipschütz ulcer?

Healthcare providers aren’t entirely sure what causes Lipschütz ulcers, although they think they’re related to infectious diseases like Epstein-Barr virus (EBV) and other viral or bacterial infections. For example, perhaps your immune system has a severe reaction to an infection or virus and produces the ulcer in response. 

Some of the known viruses or bacteria that can cause Lipschütz ulcers are:

• Cytomegalovirus (CMV).
• Influenza A and influenza B.
• Mumps.
• Salmonella.
• Mycoplasma.
• Group A Streptococcus.
• COVID-19.

But in many cases, there’s no direct history of a virus or infection.

Is a Lipschütz ulcer contagious?

No, you don’t acquire a Lipschütz ulcer through physical or bodily contact.

What are the risk factors for a Lipschütz ulcer?

Anyone with a vagina can get a Lipschütz ulcer. Being younger than 20 and having a recent history (within a few weeks) of a viral or bacterial infection can also increase your risk.

What are the complications of a Lipschütz ulcer?

Lipschütz ulcers don’t cause long-term health complications and heal on their own. If you experience complications, they could include:

• Scarring. If the ulcer is large or deep, you may notice a spot of discoloration due to scarring.
• Emotional distress. The ulcer can be painful and affect your quality of life overall. Since it’s a rare condition, it may be mistaken for a sexually transmitted infection (STI), which may cause anxiety and affect your self-esteem.
• Being unable to pee. While rare, the location of the ulcer may make it hard to pee, causing urinary retention. This could require needing a catheter (long, thin tube) to empty your bladder.

How is a Lipschütz ulcer diagnosed?

Healthcare providers will perform a visual examination and review your symptoms and medical history, including any current viral or bacterial illnesses.

Most often, they begin by eliminating more common causes of genital ulcers like those due to sexually transmitted infections (STIs) or conditions like Behçet’s disease.

What other conditions have similar symptoms?

A differential diagnosis is a list of other conditions that produce similar symptoms to yours. Your healthcare provider may begin their diagnostic process by considering several conditions that may produce genital ulcers or lesions. Some of those conditions are:

• Genital herpes.
• HIV.
• Syphilis.
• Sjögren’s syndrome.
• Behçet’s disease.

Is Lipschütz ulcer an autoimmune disease?

Healthcare providers haven’t categorized it as an autoimmune condition. But it has a close connection to other autoimmune conditions, possibly being a precursor (coming before) to certain autoimmune diseases.

How do you treat a Lipschütz ulcer?

You don’t always need treatment for a Lipschütz ulcer. Your healthcare provider will discuss ways to manage the pain and discomfort the ulcer causes.

Some possible treatments include:

• Taking sitz baths. A sitz bath involves sitting in a bathtub filled with a few inches of warm water. The warm water helps soothe the area.
• Avoiding wearing tight clothing or underwear (when possible).
• Using over-the-counter (OTC) pain medication like acetaminophen or ibuprofen.
• Applying a topical anesthetic (like prescription or over-the-counter lidocaine) to numb the area.

Some severe cases require an oral or topical corticosteroid to help with healing. If there’s an underlying bacterial infection, your provider will prescribe antibiotics.

Small ulcers may respond well to at-home treatment, while larger ulcers may require medication to manage the pain.

Do Lipschütz ulcers go away?

Yes, they tend to go away within two to six weeks.

Can I prevent a Lipschütz ulcer?

No. Because healthcare providers aren’t entirely sure what causes it, it’s unclear what you can do to prevent it. Since there may be a connection to your immune system, maintaining your overall health to reduce your risk for viruses and infections can be beneficial. Some tips include:

• Reach for nutritious foods like vegetables, fruit and lean protein instead of processed foods, desserts or foods high in saturated fats.
• Practice safe sex like using a condom. While a Lipschütz ulcer isn’t sexually transmitted, infections transmitted through sex can affect your immune system and overall health.
• Get quality sleep and manage stress levels.
• Wash your genital area with mild soap and water daily and launder your clothes regularly to reduce the risk of bacterial infections.

What can I expect if I have a Lipschütz ulcer?

Most Lipschütz ulcers heal on their own within two to six weeks. Scarring and other complications from Lipschütz ulcers are rare. It’s rare for a Lipschütz ulcer to come back (recur).

If your pain is intense and affecting your quality of life, ask your healthcare provider about options for pain relief.

When should I see my healthcare provider?

Contact your healthcare provider if you have symptoms of a Lipschütz ulcer. These symptoms include:

• A painful and deep genital ulcer, most likely on your vaginal lips (labia).
• Flu-like symptoms such as fever, fatigue and body aches.
• Recent viral or bacterial illness.

While there’s no one treatment for a Lipschütz ulcer, a healthcare provider can make a diagnosis and help you manage the pain and discomfort.

A note from Cleveland Clinic

A Lipschütz ulcer is a rare genital ulcer that doesn’t happen due to sexual contact. Healthcare providers are still learning more about this condition to determine what, specifically, causes it. Talk to your healthcare provider about your diagnosis and what they recommend to ease the pain and discomfort. You don’t have to let a Lipschütz ulcer affect your quality of life while it heals.