Aunt Vadge: Small red dot on clitoris – what is it?

Hi Aunt Vadge,

Four weeks ago I had sex with my boyfriend for the first time. It was also the first time I’d had sex in about two years. We used a condom. (It was latex and I’ve requested that we no longer use latex condoms.) Approximately 24 hours later, I began experiencing itching that reminded me of yeast infection symptoms. The itching only occurred at and around the vaginal opening which was also sore and agitated in general. I had slightly abnormal discharge, nothing crazy – no odor.

Upon visual inspection, my clitoris was quite red and swollen and there was a small spot on my clitoral hood that had a pinching sensation when touched. After using OTC yeast infection medication both externally and internally for 3-4 days I was very pleased that everything had calmed down and looked healthy and normal.

The only thing that 4 weeks later has not gone away is that small spot in my clitoral hood. 99% of the time, I feel nothing. No discomfort while sitting, walking etc. I only feel it sometimes when wiping and always while washing in the shower. Why won’t this skin heal? I have refrained from ALL activity down there. I’ve tried vaseline for extra protection and THOUGHT I noticed improvement but I think I’m kidding myself. It has not gotten worse – it’s just the same! There is no pus, no flaking – just a slight redness and a small pinching sensation when touched.

Please help!

Yours,
Spotty
Age 33, USA

Resolved – it was yeast that had grown legs! 

_______

Dear Spotty,

Based on your symptoms – itching plus a slightly sore red spot on your clitoral hood that won’t go away – it is very hard to pinpoint precisely what that might be.

It seems that you have either had a very distinct reaction to the condom, or the sex has been a bit rough and has caused the inflammation of you clitoris. Or, a bit of both.

Some options

The thing with small wounds that won’t go away are the contributing factors, and microbes and the immune system must be suspected, since you are presumably not repeatedly cutting yourself. This means there is something keeping the small spot inflamed that is coming from inside your body, and we have to assume it is not yeast, since you have already treated yourself with antifungals, which leaves another type of fungus, or your own immune system. Immune-related inflammation (think asthma, hayfever, eczema, psoriasis) can trigger small bouts of skin eruptions, which can cause small red bumps, lesions, or other blemish on your vulva and clitoris. This could include genital psoriasis.

You are right to point the finger at condoms, and that would be my first suspicion, which would fit in with the immune-related response – a small allergy could have triggered off the immune system, which has resulted in the small spot not disappearing.

Take a look at the rest of your body and health. Have you developed any other allergies or intolerances over the past few years? Are you sensitive to smells and chemicals, or get hayfever or eczema? Our immune profile changes all the time, and with the influx of ‘life’ poisons in food, water and the air, everyone is becoming a bit more sensitive. It is quite common to develop allergies later in life for ‘no reason’, but regulating the immune system in these cases would be of critical importance – something is going on that needs your attention.

It would pay to go and see a doctor to be examined, and while it seems unlikely to be a sexually transmitted infection (proper use of condoms works very well), it is useful to get tested for everything to rule it out so you can move on to finding the solution. Once you have been examined by someone who knows the vulva well (a regular doctor isn’t necessarily the best option here), you will get a diagnosis you can work with (or they will throw up their hands and declare your case a mystery!), and for sure they will offer you some kind of topical medication (probably steroid cream, more anti-fungals or antibacterials of some kind) to get rid of the spot.

These creams, for some people, can just clear it up and it never returns, but if you have a deeper systemic immune reaction going on, and there are sustaining causes in your daily life, the problem is very likely to reappear. This is why it’s important to not try to diagnose yourself at home – if it’s a sign of a more serious thing, you need to know about it. Lots of diseases seem improbable based on the very clear reaction you’ve had to something in the sex, however underlying disease can manifest after a disruption of the skin such as sex with a condom, after a long time without the contact.

It is a really good idea to figure out exactly what it is very early on, because treating things early almost always results in better outcomes. Don’t leave it to see if it goes away – four weeks is long enough. It isn’t going away, and even if it does, you can’t ignore what your body has just told you. Check your lifestyle, check your diet, don’t be complacent. Immune system oversensitivity stems from somewhere. Find the cause.

It would be wise to wait for a diagnosis to treat the problem properly. If for some reason you are not offered a satisfactory diagnosis or treatment, find another doctor. It shouldn’t be too hard to identify what the problem is, and how you treat it after that is where it gets more interesting. You have a couple of options – gynaecologists work with the vulva and vagina all the time, but dermatologists work with the skin, so figure out who would be the best doctor for your problem. If you do choose a dermatologist, find one (by calling ahead) who has experience treating vulvar issues. I also understand that the US offers healthcare to those with money or insurance, which can make doctor-hopping an expensive operation, so go through your regular channels to at least be examined by a doctor, and see what they say.

To help reduce the immune response while you wait, you can try high-quality fish oil (1,000 EPA per day, check the back of the jar for EPA content of 1,000mg capsules, probably a few capsules) and vitamin D capsules (4,000IU per day) for two weeks at least to see if there is any change. Take the capsules with fatty food (avocado or nuts, perhaps), as the fat-soluble vitamins are absorbed more easily when taken with fatty foods. Eat a healthy, clean diet, avoid irritating the area, and be good to yourself. The immune system responds well to love and laughter!

Take photographs of your vulva now so that you can show the doctor, just in case the problem disappears before you get a chance to see someone, and keep a clear diary of all your symptoms, starting before this occurred too in case there is a correlation. This sort of reaction doesn’t happen for no reason, and there could be something in your history that may help to diagnose you more accurately. Your symptoms include those that have absolutely nothing to do with your vagina, like more colds and flus, aches, pains, small dysfunctions or annoyances, changes in diet, lifestyle, stress levels… you get the drift. It may not just be a local problem.

Please write back to us and let us know how you went! We’d love to know the outcome, and if you want help to treat anything that isn’t already set up on the site, ask – we are slowly building the site and are taking requests.

Warmest regards,
Aunt Vadge

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
Read more about Jessica and My Vagina's origin story.