I’ve occasionally gotten white heads, but it’s been awhile. Once time I had an abscess that had to be cut out and required five stitches - the doctors were shocked it wasn’t just a cyst. Maybe your underwear could be causing it? I ditched all my cotton underwear that would always stay moist and finally found some that are actually wicking: SOMI apparel, boody bamboo, and jockey tactel (I think?) are my favorites. My second idea would be to ask if you’ve tried different soaps? Or how often you’re showering? I’m sexually active, sometimes use toys, sometime exercise, and sometimes shave — so I don’t think those would worsen it much. That sounds like it can be painful, I hope you find some answers!

I wonder at this point if antibiotics would be helpful.

I've never experienced much acne on my labia, I assumed any I did get were from ingrown hairs. Deep skin acne, cystic acne, has improved with the avoidance of cinnamon. It's taken me so many years, and my third child who's allergy response is more severe and shows as hives on him, to figure out cinnamon was not metabolizing in my body and causing the cysts to push out as acne. Cinnamon hides in so many things, for example: teas, liquor, chocolates, bbq sauce, Chick-fil-A sauce, common desserts, etc It takes months of strictly avoiding cinnamon for the particles to all flush or push out of our bodies, but try to keep it up for at least 6 months to a year. If you have chronic acne in other places or other skin conditions like dandruff or eczema, I believe that may get better too.