How’s your vulva doing?

All vulvas are beautiful!

(That link is a bit NSFW, but it’s line drawings, not photos. I just wanted to get your attention).

I’m famed around this here blog for yapping on endless about vaginally related things — periods (my evergreen post about geriatric menstruating, periods and covid vaccines (remember that??)), period coloured paint colours, middle aged menstruating, catching lotuses with my vagina, menopause (twice), menopause , vaginal atrophy. Etc. So when I said to the blog group last week, “hey, I went to see a gynaecological dermatologist,” Sam naturally said “blog about it.”

Yes, vulvar dermatology. A very niche sub-specialty. I often work with OBGYNs and I had never encountered it before. But I am a fair-skinned human with a constellation of skin conditions, and I have a vulva, and it is inevitable that my aging vulva and inflammatory skin conditions would eventually encounter each other.

Like a lot of pale people of northern european descent who spend time in the sun, my body dis-ease often manifests in my skin. I’ve had a basal cell carcinoma removed from my nose, routinely have to have pre-cancerous cells blasted off my face and shoulders, get eczema-rashy at the slightest provocation, and I have a much more severe condition called hidradenitis suppurativa, which manifests quite terrible lesions in my groin and armpits (I do not recommend clicking that link unless you really want to level up your titillation about gross skin things beyond Dr Pimple Popper).

So I wasn’t surprised a few months ago when my dentist peered into my mouth and said, hm, have you ever heard of lichen planus? (Swelling, irritation, bumps, lesions, all the good stuff). Like most skin-related ick, no one really knows what causes it. Most explanations are a kind of shrug about auto-immune responses (I have a belief that three decades from now we will view our current understanding of the immune system as akin to the four humours. Leeches, anyone?)

Anyway, once I read about the lichen planus in my mouth, I made an aha connection to the condition of my labia. Another mucosal tissue. Red, burning, sore, tight. I’d assumed it was just ye olde menopausal vaginal atrophy, and was slathering on the hormone creams and aging-friendly lubricants. But the visual inspection (ahem) plus the description of vulvar lichen planus (no link because lots of icky photos) made me realize that was probably what was going on. So I presented myself in all my glory to my fancy dermatologist at my usual biannual check in.

Oh, the images that show up when you google “images, vulva”. All images from unsplash.

Turns out it was indeed vulvar lichen planus. This condition can cause scarring, skin fusing (fused hood of the clitoris! fused labia!), infections and squamous cell carcinoma of the vulva. Skin cancer. In the labia. This condition most often shows up in among people in their 50s, so it’s likely somehow menopause related, but who knows.

As a person who enjoys cycling, sex and peeing without pain (and just, you know, having labia and a clitoris), I was glad that the second line of topical steroid treatment seemed to work, according to the fancy vulva dermatologist (I’m also chronically on doxycycline to keep the other skin condition under control). I’m much more “comfortable,” as the euphemism goes.

So why am I telling you all this? Because one of our goals here at the blog is to keep people active and moving as long as possible. If you’re still experiencing any kind of pain, burning or dis-ease in your vagina or vulva, tell your doc. It’s common to have these experiences as we age, but we don’t have to live with it. Protect it from cancer and ripping and use it fully. Run free — enjoy your vulva.

Fieldpoppy is Cate Creede-Desmarais, who rides their bike without pain in Treaty 13 Territory in Ontario.