Aunt Vadge: long-running cut and thickened vulvar skin

Hi there Aunt Vadge!

About two months ago I noticed a had a small cut/lesion (1.5cm) above my clitoris, right where the two lips meet. I thought perhaps I has scratched myself with my nail when wiping after going wee, though I couldn’t recall having done so. However, it still hasn’t healed now two months later, and I am feeling concerned. My husband just now told me that after we had oral sex recently that my clitoris felt different, almost a bit leathery.

Also, just to add to the picture; I am presently signed off work for three weeks for stress, exhaustion and just generally feeling rubbish all the time. There may be no connection at all, but thought I should mention it. Thanks so much for any advice.

Sincerely,
Concerned
Age: 57
Country/Area: UK

Dear Concerned,

It sounds like you definitely have something going on that needs to be checked out, so I would advise seeing your GP for a referral to a vulvovaginal specialist (not just a gynaecologist). You need someone who is an expert in vulvar conditions so you get the best advice first to save you time and a drawn-out diagnostic process.

Stress – especially over a longer period of time – really burns out your immune system, so it would make sense that the cut had been there for two months, and at the end of that two months you are off work, burnt out with strange things appearing. It’s more important than ever that you get a handle on your stress, because those stress hormones – cortisol and adrenaline – block most of your normal body functions, including immunity. You sound like you’ve been fighting an uphill battle for some time, so think back to how long you have been stressed, and then look at what is happening to your body. You sound like you are seriously depleted and your adrenals are probably out of steam.

This situation is not uncommon, but I like to think of it in a very practical sense. That is, those stress hormones make everything else stop except your muscles. You have a finite resource in your adrenal glands, and once they’ve pumped out all their juice, you end up tired all the time, because you simply have none left. You have run out of juice.

The solution to running out of juice is only to rest and rejuvenate, and that takes time, slowing down, and figuring out how to adjust your stress response so that things don’t trigger you off all the time. This is obviously easier said than done, but there are scientifically proven tools for managing your adrenaline and cortisol, plus a bunch of herbs, foods and other supplements that will help to rebuild your adrenals. But, you can’t rebuild your adrenals until you stop depleting them the minute they have some juice in them. This means you need an overhaul of the way you manage your life and the stressors it presents you with.

Tools to manage your stress response and actively reduce cortisol and adrenaline levels are mindfulness and meditation (proved by science!), gentle exercise, laughing and art. There are obviously many more, and you will have your own favourites to draw on. Actively make a point of relaxing your mind and body every single day – that’s your new job. You have to talk your own self down off the cliff here, because nobody else can do it for you. You are suffering exhaustion, but you are in charge of your body and mind, so you have to be the boss of your recovery.

I would recommend finding a professional person (my vote is a really good naturopath that you like and trust) to walk you through this, because trying to think up strategies when you are exhausted is going to likely to be too much of an ask. So, hire someone to hold your hand. There are some excellent herbs that will help your adrenals recover, while also managing your stress response so that you can rest.

How you go about your recovery is going to be up to you, but I would suggest planning for a lot of rest. Cancel your social calendar, start figuring out stress-management strategies, and lie down and read a book! Sleep. Eat good food. Rest. There is no other way. Exhaustion only has one (good) solution. Obviously stress has a cause, so I’m not sure what’s been going on in your life to cause immense stress, but you’ll need to figure out ways to prioritise self-care over anyone else in your life that you are expending your care and stress energy on.

It seems (without any further information) that you are suffering the effects of prolonged stress exhaustion and that is – sort of indirectly – why your vulva is playing up, but it doesn’t mean that your vulva does not need attention. So, on a more practical level, you may have developed – due to your body being used up and thus your immune system depleted – a vulvar skin condition or autoimmune issue. One of the major issues with stress is that it really robs your body of resources at a much faster rate than it would normally.

Your brain and body pumps through your nutrients, which you can’t replace fast enough. It also doesn’t help that stress really interrupts our appetite, digestion, and ability to care for ourselves. It’s a very unfortunate catch-22. If your immune system and skin are missing some critical nutrients, things start to go wrong. I wouldn’t be surprised if you noticed other things going on in your body too, little niggly things that have appeared recently.

Usually past menopause vulvar skin tends to thin out, as opposed to thicken, but cuts and tears are sometimes a daily fact of life for menopausal women, particularly cuts that won’t heal. As we lose oestrogen, the strength and robustness of our skin can really suffer, even if we’re not that old. You may benefit from an oestrogen cream safe for use in menopause or another form of ‘top-up’ for oestrogen.

It would pay to check out lichenoid conditions, which are autoimmune conditions resulting in thickened (lichenoid) skin, particularly on the vulva, to see if you symptoms match. You need a diagnosis above all else, so make sure you don’t go home empty handed with steroid cream! Steroid cream is useful but without a diagnosis, you are wasting precious time – lichenoid conditions can really wreak havoc if not treated promptly. You feeling off and having to take time off work may be unrelated, but it also may not be.

Your vulvar cut and skin thickening could also be a form of dermatitis – contact dermatitis, allergic dermatitis, etc. You may have a bit of a time ahead of you in getting a diagnosis, but aim for the best professionals to cut down on wasted time. You may also like to consider a vulvovaginal dermatologist.

There are a few other options, but these are the most obvious and common.

If you get stuck after your appointment or don’t understand or agree with anything I’ve said, feel free to write back anytime and we can talk about it.

Warmest regards,
Aunt Vadge