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Dear Aunt Vadge,
I’m 19, from the UK. I read your article on vaginal fissures and I’m not sure which category I fit into.
I’m on the contraceptive pill and have had cuts for a year now. I’ve avoided getting it checked out in fear it could be herpes. The cuts appear on the inner pink bits, look like paper cuts, sting and itch, sometimes several at once. They come every 3–5 weeks and aren’t as severe as they used to be.
About 18 months ago I had three months of terrible urinary tract infections, often after sex. They cleared up, but I’d associated sex with them, so I got very anxious about sex, which caused a lot of vaginal dryness and pain.
We now use lubrication and can have sex comfortably, though not perfectly. I can self-lubricate again, but my libido is very low (possibly the pill), I still get pain for the first few minutes after penetration, and the cuts still appear out of the blue. My boyfriend is understanding and patient.
My vagina is generally very dry if I touch it when washing, and it cuts very easily. The cuts are never at the entrance, just on the lips. Something doesn’t feel right. I feared herpes, but after reading I’m unsure, as these are paper-like cuts in a concentrated area, not blisters or sores. I also get a sting/burn when my boyfriend ejaculates in me.
Any advice would be greatly appreciated.
Broken
Hi there Broken,
Thank you for such a detailed letter – it gives me plenty to work with. And your instinct is right: this doesn’t read like herpes. Herpes shows up as blisters and sores that crust over, whereas you’re describing fine, paper-cut splits in the same area, on dry, fragile skin. That’s a different pattern.
What it reads like is a skin that’s too dry and delicate to hold together, and there are two big drivers worth chasing. The first is your pill. Hormonal contraception can lower the free oestrogen and testosterone your vulva relies on, which shows up as exactly your cluster: low libido, dryness, and thin, easily-split skin. Oestrogen is also what prompts your vaginal cells to release glycogen, and glycogen is the food your protective bacteria live on – so when oestrogen is low, your protective bacteria dwindle, which may well have contributed to that run of UTIs too.
The second thing I’d want a doctor to rule out in person is a skin condition called lichen sclerosus. Recurring vulval splits in the same spot over a year, on fragile skin, is a classic presentation, it’s under-diagnosed in young women, and it’s very treatable once named. Your fear of being checked is completely understandable, but this is exactly why getting seen is worth it – so you can stop guessing.
The sting when he ejaculates fits this picture too: raw, fissured skin gets stung by semen. It’s the tissue being fragile, not usually a separate problem.
So the plan: see your GP or a sexual health clinic (both free and confidential on the NHS), get examined, and specifically ask them to check for lichen sclerosus and to talk through your pill. It’s worth asking whether a non-hormonal option – condoms with a good water-based lube to start, and there are others on our contraception page – might suit you better, at least for a while, to see if your dryness and libido recover. Don’t stop the pill on your own without that chat, since you may be on it for reasons beyond contraception.
You’re keeping up the lube, which is exactly right, but lube manages the symptom rather than the cause, so it’s worth pushing for the underlying answer. In the recurrent-fissure cases that reach me, a good share come down to either low-oestrogen fragility or lichen sclerosus, and both are very fixable once you know which you’re dealing with.
You’re 19 and your body bounces back well when it has what it needs, so I’m optimistic for you. Get it looked at, and you can stop carrying the herpes worry around.
This is general information, not a substitute for personalised medical advice.
Write back anytime with what they say.
Warmest regards,
Aunt Vadge
