[I will be using anatomical terms in this post] To help anyone searching the sub: acne is also known as: pimples, spots, cysts. (let me know if I missed any terms)
GENITAL ACNE IS SUPER NORMAL AND NOT UNCOMMON.
I have included all information to be as thorough and informative as possible.
If you want to jump straight to the tips go to that section. Feel free to add anything you know from your own experience in the comments! Let's help each other out
Background
I personally had to figure this out within 2 months of starting testosterone at the beginning of this year. I'd never experienced genital acne before (I'm 42) so it was kinda worrying and very uncomfortable. I am really good at medical research though as I have complex medical conditions so I did a ton of research and trying things out. I have also dealt with sebaceous cysts before and it's not dissimilar treatment.
I wanted to write up a post on this for a while as I've seen it come up more and more.
Where do we get genital acne?
It can literally come up on any of the genital skin. I've had it on the outer labia, inner labia, around the entrance to my vagina on the lower inner labia, and on my foreskin. I've seen some people post on here with one under their foreskin or even the crown of the head of their dick. It's all normal.
It's not necessarily about how clean we are
Genital acne is super normal and happens because our genitals are made of skin with pores. From my research it seems to be more common in amab people and so my guess would be that trans-masc people can start to experience it for the first time during our second (testosterone driven) puberty. It's likely because on testosterone we sweat a lot more. We also have unique anatomy compared to cis men and amab people where our dicks are basically sandwiched between our scrotums and we have anatomy that produces more fluids. Good hygiene can improve the likelihood that acne doesn't occur but we can still get acne even with daily showering, especially if we're prone to it. Just like anywhere on our bodies.
Testosterone puberty and FTM transition
As we know there's a lot of changes in our transition that aren't talked about medically or even outside of smaller communities like these. Here's some that's important to the acne problem.
What starts out as our outer labia becomes much more scrotum like. For me this has meant multiple things:
- More hair - denser, grows in different places, thicker hair.
- Fat greatly reduced in the outer labia.
- The skin changed and feels softer, more pliable, and thinner like a scrotum.
- This skin sweats a lot more and also folds on itself more creating more sweat. The sweat definitely smells masculine.
- What I produce when I orgasm has more substance to it so I'd guess this includes more proteins or other things that could block pores.
In particular, my hair now grows all over this now scrotal-like skin even on the insides of the outer labia folds and up to and including what is the inner labia. This was so supremely uncomfortable and even painful that I have had some laser treatments to soften and reduce the hair.
Our dick and (what was the hood) foreskin grows significantly and this skin also changes texture and is very much dick and foreskin skin. It's got a very different appearance and texture to pre-testosterone and matches my experience of cis dicks. This means multiple things:
- This skin sweats.
- It has more pores.
- It has more contact with other skin and sweat transfer from the outer labia/scrotal skin.
- Our dicks are like uncircumcised cis dicks which mean we have to maintain the hygiene of someone who is uncircumcised.
What is genital acne
Genital acne like any other acne are blocked or infected pores in our skin. They can range in variety from and include:
White heads - they don't look much like white heads on our face or the rest of our body as the skin is slightly different. They are much less likely to pop or open up and are more likely to resolve without the skin breaking. This means they heal slower but this is better in the long run! They often look like they're fluid filled with a thinner layer of skin on top.
NEVER POP THEM.
Cysts - sometimes these can become cyst-like. They are deeper, swell more, and are painful. These will be very similar to other cystic acne on our back, butt, or body. Often they're a lot smaller though. They can be hot to the touch and hard if they are inflamed. They can get bigger before they resolve don't worry if they do just follow the tips below.
Bumps - either of these could just start out as small sore bumps but never develop beyond that. Checking your skin regularly can alert you before they become cystic.
Again,
GENITAL ACNE IS SUPER NORMAL AND NOT UNCOMMON.
Even someone with extremely good hygiene practices can experience it. It is more common during puberty and for some of us it's just inevitable.
Things that are likely to cause it and what else to do instead
I've personally figured out these things are more likely to cause genital acne, but sometimes it is also just unavoidable and happens anyway. Either way try to avoid or reduce the following:
- Skipping showers. I know it sucks. I used to be able to shower 3 times a week no problem. Now I have to shower daily. If I absolutely can't (disability) I always use a wipe on my genitals - a water based baby wipe is best. For worst-case-scenarios/a lot of sweating I have "intimate wipes" with tea tree oil. Don't use these between the inner labia/around the vagina or urethra.
- Sitting for a long period of time. I think the sweat builds without much opportunity for airing things out and drying off because of our anatomy/folding of skin. The first time my genital acne became cystic was on a 12 hour flight.
- Not cleaning after sex, masturbation, or even pumping sessions. We can't always have a full shower right after. I use baby wipes to clean up as thoroughly as possible. I have had acne even caused by high quality water based lube alone. Sex with another person in particular will introduce the bacteria that live on their skin. We can have really unique biomes and some people even have strep-type bacteria or MRSA living on their skin peacefully (for them) but not us.
- Not cleaning after working out/a long day rushing around doing errands etc. See the first point. Use wipes if you can before bed.
- Oil based lubes. Some of us just can't use this and it will block pores, especially with pumping, sorry.
- Pumping. This one is unfortunate especially in this sub. I still pump, but cautiously with the right lube and cleaning. My theory is pumping can stretch the pores and such and cause more dirt to enter them or get trapped.
- Stand to pee devices. Sad, I know. I use a spouti and even with the spouti if I get a small leak or moisture and let it sit for too long = acne. Again, wipes are good. Taking individually wrapped ones for long days out is important. Even drying off with a facial tissue discretely at urinals improves the odds of acne.
- Masturbating without washing hands. I know, I know sometimes you just gotta get to it. It's like face acne tho - there's so much dirt and bacteria on our hands and nails, if we touch this skin too much it'll cause acne. Keep baby wipes and hand sanitizer near your bed or something idk. Be sure to wait for the alcohol to evaporate if you go that route.
- Physical activity and friction. If you already have acne, it's become cystic or inflamed, any physical activity, even a lot of walking can make it worse - more swollen and painful and take longer to clear up. Remember it's sometimes about damage to the skin. Try to take breaks and spread your skin out to give it air and reduce friction.
- If you have fragile/delicate skin. I have a connective tissue disorder and I think this is why I can be prone. See the above point.
- Tight underwear. Once we have enough growth we might need to wear boxers to give our genitals room to grow and breathe. If they're cheap they may not be breathable enough. If you prefer wearing feminine underwear make sure it's breathable and not too tight.
- Waxing, sugaring, and shaving. The pores get damaged and blocked with these types of hair removal as they're destructive, I'm sorry. This doesn't happen with laser or electrolysis based hair removal.
- Long or a lot of hair. The more hair you have the more you have to be diligent about cleaning it and maintaining things. Try trimming with clippers if you prefer to have hair.
The soap and water myth - important!!!
I get where this comes from - as people with a vagina we're told not to use soap with fragrances or anything that is not meant for a vagina or pH balanced for it. We are yelled at constantly that plain water is enough and if we must use soap it should be unscented and mild.
This just isn't true for some of us and specifically is ONLY about a vagina, not the rest of our genital area.
While it's true that this is how you should treat your
vagina it's not necessary for the entire area. I would even go so far as to argue:
with FTM transition, enough changes in our anatomy that we no longer have what is a typical vulva.
We would never tell cis men/amab people to only ever wash their scrotum or dick with water or plain unscented soap.
I absolutely must use body wash down there now - specifically on my dick and outer labia/scrotal skin and between my outer and inner labia. If I don't I stink to high heaven and it's a guarantee to get acne. However, I do use mild sensitive skin friendly body wash from Dove Men Care+.
The important thing is to not use this down around your vaginal entrance or urethra and never internally. Up under your dick and even under your foreskin is fine imo. If you experience irritation adjust as needed.
Foreskins: Some people may experience a dry head/under the foreskin area if they do this every day, so use water under the foreskin every other day. I personally am fine with the body wash and never have trouble with lubrication under there.
It's cool that some of you can get away with plain water or what have you, it's just not possible for some of us, especially after transition and during 2nd puberty.
Tips: what to do about genital acne and how to clear it up
PATIENCE IS KEY: NEVER POP OR SQUEEZE IT. The more trauma your skin is under the more it'll get inflamed, painful, and swollen.
It will take longer to heal.
!!! If you get broken skin it can get infected
!!!
Acne often gets worse before it gets better. Trust the process and actively work on healing it.
- Hot compresses or bath
The heat reduces inflammation and promotes healing.
Wet a CLEAN face towel, wring it out, heat it in the microwave for 1-2 minutes. Be careful it's not too hot and apply it to the affected skin. Reheat and keep applying over 10 minutes at a time 3-4 times a day.
Alternatively a hot bath will do the same. It can just be a shallow one - whatever it takes to soak this area. When traveling this may be all that's possible. A hot shower directed at the area could achieve the same. 10 mins, 3-4 times a day.
This is especially critical for anything that becomes cystic. It might be the only way to really heal it.
- Keep it extra clean
Baby wipes, intimate wipes, whatever it takes. 2-3 times a day. As I said I also have intimate wipes that have a VERY small/low percentage of tee tree oil in them.
- NSAID like ibuprofen
If it's cystic, hot, painful, swollen, and being stubborn an NSAID can help. A half max dose every 4-6 hours should be plenty. Don't take this if you have any medical contraindications.
- Benzoyl Peroxide
Yes, it is safe to use this on genital skin. Be careful to avoid the vaginal entrance and urethra though. You can get both:
- 4% benzoyl peroxide wash (body or face)
- 5% benzoyl peroxide cream
Brands will depend on where you live. Google these things or search amazon and you'll find them. In Canada/US I like CeraVe wash and Neutrogena cream. I actually don't use the wash on my genitals, I don't find I need it - just my back and butt. You may find you need it.
I do use the cream on my genital acne when acne pops up. It helps dramatically speed up the healing and clears things up. It also reduces the chances of it becoming cystic. Apply in moderation a couple times a day. Be careful about not spreading it all over.
I have used it everywhere from my foreskin to my outer labia/scrotal skin, and even on my inner labia where I have had acne on the edge of the hanging skin (I have larger outer labia).
Test on a small area of skin first and if you get irritation or a reaction stop using it.
Things I tried that didn't really work
Your mileage may vary but these things didn't work for me although I used them a lot at first and thought maybe they did:
- Medicated antibiotic ointment like neo/polysporin.
- Antiseptic ointment like germaline.
- Various ingrown hair/bump creams.
- Other acne cream that is not benzoyl peroxide.
- Tee tree oil or witch hazel - probably works a little but VERY drying and can cause burns.
Some sources
So you know I'm not full of shit or sharing things that are dangerous. AGAIN THOUGH, I think we should take the soap advice to typical AFAB/vulva owners with a grain of salt when we are FTM.
https://www.teenvogue.com/story/how-to-treat-vaginal-pimples-and-acne
https://www.health.com/condition/skin-conditions/vagina-pimples
https://www.healthline.com/health/womens-health/vaginal-pimples#_noHeaderPrefixedContent
There's many more articles out there that I referenced in my original research when dealing with this, but these were the best. I've tried to tailor this post specifically to our FTM experience.
Let me know if you have anything to add or anything else! I hope this helps anyone who finds it for a long time to come. You're not alone
)
not seeing gender in true love
