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Hi Aunt Vadge,
I have a vulval lesion in the crease between my inner and outer labia. I saw a doctor and was diagnosed with bacterial vaginosis. They tested me for STIs and swabbed the lesion – it isn’t herpes, and everything came back negative. The doctor told me to put an over-the-counter antibiotic ointment (bacitracin zinc) on it until it healed. It felt healed, but after sex with my partner it came back.
I’ve had it about three weeks. It doesn’t hurt or weep, but it itches. It’s skin-coloured unless irritated, then reddish, about an inch and a quarter long, and only slightly raised. The only thing that changed was having sex on two consecutive days. I don’t have insurance, so I’m trying to work out whether I need to go back.
I’m allergic to cats and some dogs, sensitive to dairy, and very sensitive to scented soaps – I get razor burn and a UTI-like feeling. I recently moved states and came out of a six-year relationship, both good changes but stressful. I got an oral antibiotic for the BV and it seemed to improve, but my BV keeps recurring even on probiotics. We don’t use condoms, but he doesn’t ejaculate inside me. I’ve used coconut oil on the lesion. I’ve had some digestive issues and headaches (I also moved to a much higher altitude). No known autoimmune conditions in the family, though my mom and sister are allergic to sulfur.
Sincerely,
Sensitive, age 28, Colorado, USA
Dear Sensitive,
Thanks for such a thorough letter. I can’t tell you exactly what the lesion is from here, but I can give you the shortlist worth ruling out, and a plan for working through it without spending money you don’t have to.
What a persistent labial lesion can be
- A lichenoid or dermatitis-type condition – lichen sclerosus, lichen planus, or a contact/allergic dermatitis
- Genital psoriasis
- Less commonly, precancerous or cancerous skin changes
The itch you describe is classic for the lichenoid and psoriatic conditions, and the fact that it’s recurring, and re-triggered by friction from sex, fits an irritable, reactive patch of skin rather than a simple infection. Your history of allergies and sensitivities suggests an immune system that’s quick to react, which makes those inflammatory skin conditions more plausible.
Here’s the honest bit: a lesion that keeps coming back for three weeks is not something to just keep dabbing ointment on indefinitely. It does need eyes on it eventually, because the one thing you want to rule out for certain is any precancerous change. Catching those early makes them very treatable.
What to do without insurance
Since money is a real factor, be strategic:
- Take clear photos every few days so you can see whether the lesion is changing, growing or resolving. That record is genuinely useful and free.
- Keep a symptom diary – itch, irritation, what makes it flare (sex, shaving, soaps).
- Read up on the conditions above so that when you do get seen, you can steer the visit and not waste it.
- When you can, see someone who actually knows vulval skin – a gynaecologist, or a dermatologist with vulval experience (ring ahead and ask). A low-cost community or women’s health clinic is a good place to start if cost is the barrier. Examining and, if needed, biopsying the lesion is a doctor’s job – it’s not something we do here.
In the meantime, keep it simple on the skin: warm water only, no scented products, no shaving over it, and stop having sex over the lesion while it’s active so you’re not re-tearing it.
The recurring BV
Recurring BV that bounces back after antibiotics is its own puzzle, and antibiotics alone often don’t hold it. Our free how to treat BV resources walk you through the microbiome approach step by step at no cost, and if you want the full structured protocol, the Killing BV plan is there too. Getting the microbiome back on its feet often settles the low-grade irritation that keeps skin reactive.
And be kind to yourself on purpose – a big move, a breakup and altitude all stack up, and stress genuinely lowers the threshold for this kind of flare.
Write back anytime if you’d like more help.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice. A persistent, changing or non-healing lesion should be assessed in person to rule out precancerous change.
