When I was diagnosed with herpes six years ago, it was a little bit of a shock. Not because I had herpes — the Centers for Disease Control estimates that 1 in 6 people between the ages of 14 and 49 in the U.S. have genital herpes, and the World Health Organization released a study in 2015 that estimates two-thirds of people in the world have the HSV-1 strain of the virus — but because my symptoms didn’t look anything like the scary pictures they showed us in sex ed. I didn’t have an array of oozing blisters and my vulva didn’t look like something out of a horror movie. Instead, it took months to see a doctor because I didn’t associate achy skin on my thighs and butt and tingling in my vulva with herpes.

But after several months of nerve pain that was so bad it hurt to wear pants and quad muscles so sore that sometimes my legs gave out and what I thought was a recurring ingrown hair that itched a lot, I walked into Planned Parenthood and asked them to swab the lesion to see if it was herpes. But it had already scabbed over, making a swab test impossible. However, a blood test quickly confirmed what I was starting to suspect: I had HSV-2, or genital herpes. That day I also found out that the other super weird symptoms I was experiencing — the tingling and the achy skin and the sore quadriceps — were also a result of herpes.

After receiving answers about what was going on below my belt, I started to get to know and understand my symptoms. I also began to notice something weird: almost every month during my period, I would have an outbreak. It would start with prodromal symptoms, which are the symptoms you get before an outbreak. In my case, it was the tingling in my vulva a few days before my period began. Then, once my period arrived, I’d get that one itchy spot between my inner and outer labia that I now knew was a lesion, an outbreak. Keysha, 23, says, “The first couple of months after my initial outbreak, I would usually get one blister on my labia during the beginning of my cycle.” However, almost a year after her diagnosis, she says she no longer gets outbreaks during her cycle, and hardly gets any at all. That’s not uncommon; herpes symptoms often get less frequent the longer someone has the virus.

Hilda Hutcherson, MD, assistant professor of obstetrics and gynecology at Columbia University Medical Center, says that herpes outbreaks may increase during the menstrual cycle, but it varies by person. These outbreaks are thought to be secondary to hormonal changes, she explains. “However, we know that herpes outbreaks also increase with stress,” Hutcherson says. “And for some [people], this time of month is stressful, [due to] discomfort, pain, bloating, fear, anxiety, or PMS. This stress might also add to increased outbreaks.”