ITCHY vulva? LICHEN SCLEROSUS?

Your privates burning or itching like crazy.?                        Spend your time scratching, or squirming?itchy vulva

Are you getting no relief from the over the counter remedies?   You maybe have been given meds/creams to treat yeast, bacteria etc.   I hope  you have, at least, been examined.   I see many women who are too embarrassed to be examined by their family doctor – only to suffer on!!

First things first.   We have to get a history.  I know it’s old, but many women are paying the price for the sale on that new detergent!   Women are all being sold sprays, douches, hoo-hah creams.  …. All to keep us not smelling. All these potions can cause a chemical reaction in our delicate parts!!

contact-dermatitis

So. Think about when this all started.  Did you get a new brand of panties,a new package of toilet paper- there are all kinds of chemicals in toilet paper.   New brand of condoms?  New soap/shaving lotion?  Are you itchy anywhere else? Your vulva is just skin, so if you have itchiness elsewhere, the itching in the vulva may be part of a body reaction.

Now, the other thing to consider is a thing called the ITCH SCRATCH CYCLE.

ITCH SCRATCH CYCLE

This happens a lot.   The original problem may be gone, but the scratching keeps the cycle going.  When you scratch, you damage the skin, and this causes the scratched skin to release chemicals that make you itch more– so you keep scratching.   Not a good set up!   We have to STOP the itching/scratching as quickly as possible.

There are other medical conditions can make you itch.   Diabetes is a big cause.   I see diabetics all the time who come in with chronic yeast infections or have a yeast dermatitis.   Let me tell you- we may be able to keep things a little better controlled, but NOTHING WORKS BETTER THAN NORMAL SUGARS!!    I don’t want to hear that your sugars are ” better ” than what they were before, and the complacency  about sugars in the double digits- and you’re ok with that.  Your sugars are either NORMAL – OR NOT!

yeast under breast

yeast pannus

Yeast under the breasts—looks same under belly , in groin , around vulva

Why do diabetics get yeast??  All you cooks know that when you are making bread, a little sugar really makes that yeast rise- so get those sugars normal!      You’ll be rubbing creams down there til you die!   Now there are things we can suggest to help you with your battle– read on under treatments.

it is also important to know if you have traveled in the last few months-one girl I saw had been in Africa, and actually had schistosomiasis (worms), of vulva—pretty darn rare!   You never know what might tip the clue to a diagnosis.

There is another condition called LICHEN SCLEROSUS, which I talk about later in this post.

So – after a history you gotta get up in those cursed stirrups, and get examined under good lighting!!

We need to check your anatomy, look for any lesions ( things that shouldn’t be there),  abnormal colouring, signs of scratching, discharge etc.   Sometimes everything can look completely normal, and all tests are negative.   That is when we try to stop that vicious cycle.

There are things you can do to break the ISC (itch scratch cycle).

Bathing in warm water with oatmeal, or Epsom salts.

If you are leaking urine, and that is felt to be cause of itching, then a barrier cream can help- baby cream with zinc oxide.   Vaseline is not very helpful.  Avoid scented pantiliners.  Get some help with treating he urine leak–incontinence is NOT part of normal aging.

Use cotton underwear.

Taking an antihistamine like ceftirazine and Benadryl.    The Benadryl may help you sleep at night.

Wearing gloves to bed to cover your fingernails.

MARITIME BIDET

We have LIGHTWEIGHT PORTABLE BIDETS (shove one in that 15 pound handbag of yours!)

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Instead of scrubbing with a FACE (Not cootie!)-cloth(and you all use those really rough FACEcloths!), and gouging your rear end out with toilet paper–use a NOVA SCOTIA (MARITIME) BIDET  (Bee-day)   eh?!?!

How the heck can anybody get quadriceps strong enough to squat over those European Bidets–is just beyond me—these ketchup bottles are lightweight, inexpensive, easy to use and require no hanging over a low porcelain bowl trying not to

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get soaked.   A patient once said she could even use a disposable water bottle—well–maybe ONCE in a public washroom–those things make a LOT of noise as they crinkle up–and don’t have the nozzle to ‘fine tune’ your aim!

CREAMS

There are are a few prescription creams that can be used.   I will often have women use clobetasol cream-a steroid cream.   Initially I will have them use it twice a day and then cut back to twice a week after a couple of weeks.  This would be long term if you have a chronic on-going skin problem, such as lichen sclerosus.

An anesthetic cream such as lidocaine, or Emla can also give quick relief, and can be a handy thing to have in your handbag.  You rub a little on the itchy area, and five minutes later you are numb – so you won’t scratch!

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I often prescribe EMLA (an anesthetic cream), for women who have pain with intercourse, due to pain at the entrance to the vagina- typically on the bottom side- at the posterior fourchette.  It can save your sex life! You only need a DOT—I literally say, “Treat it like Estee LAudee for the hoohah!”

I had a pharmacist call me one time- incredulous that it was being put ” down there”. “But- the MAN will get some on his penis!!!!!” he says!!

So, let me get this straight–It’s OK for a woman to grit her teeth in agony to make her man happy- but HE might get a little numbing cream?   Well.  Repeat after me- “He’s getting some, he’s getting some, he’s getting some.   It takes five minutes to make you numb.  It is not going to numb his entire penis, and I haven’t had one single man complain- and- typically- he’ll be ‘done’ in less than 5 minutes.  He’ll fall asleep, and when he wakes up in the morning – it’s all worn off.   Not a problem!”

The pharmacist laughed, and said, ” That’s right!”   Now I need brain bleach every time I see him-I keep thinking ‘5 mins, 5 mins!’

If you do end up getting this cream, remember that a DOT does a LOT!!  Literally a dot the size of an orange seed is plenty!

FOR YOU FLUFFY LADIES!!

The other thing you can do for vulva itching, or itching in your panti creases, or under your breasts, or your tummy muffin top, is to make sure you are thoroughly dry down there before you get dressed.   Then- you can use a deodorant stick, or roller ball- along the pantiline creases- and if you have a muffin top, you can lift that up and roll deodorant along your lower tummy bikini line.  It can do wonders to keep yeast under control- that nasty hot red skin that itches and burns.  Hey. You can rub it under your boobs too- and make sure it’s dry there too!!

Yeast – the deodorant helps a lot, and another is thorough drying.   If you feel you must use a powder (despite all these papers suggesting a link to ovarian cancer- don’t know for sure, but one law suit has been won)-then use an ANTIFUNGAL POWDER.   The powder for athletes foot works well.

If you can afford it- or you are in USA, you can get Athletes foot cream -active ingredient is clotrimazole- for ONE DOLLAR- at most supermarkets or dollar stores

Canesten $$$

yeastAthlete’s foot cream

PICTURES OF YEAST!

YEAST UNDER BREASTS

Yeast in groin

More classic yeast

 

.  I swear- clotrimazole is what we prescribe,  and costs a LOT more.  It must be the same reason women’s shirts cost more to dry clean than men’s shirts!!   Put the word “vaginal” and it costs a whole lot more than the word ” foot”.   Again- just treat this cream like foundation  make-up.  You do not need to slather it on!!

if you are in USA  (or travel there), you can pick up 1% hydrocortisone at any dollar store.

hydrocortisone

You can put a DOT of this AND a DOT of clotrimazole (athlete’s foot cream), on your finger and rub this on your skin creases,if itchy and bright red.   It is same as Lotriderm HC ($$$)

MAKE SURE YOU SEE YOUR DOCTOR FOR AN ACCURATE DIAGNOSIS!!

Now- lichen sclerosus.   Pronounced ‘like en sklere oh suss”.  Nothing to like at all!  It is a chronic- typically life long condition.  We don’t have a clue why you get it!  It is seen in young girls, but way more common over age 50.  It is a common cause of burning, and itching sensation that doesn’t go away with yeast creams etc.

An examination will be necessary, and the doctor can often diagnose by just looking at the area.   If you want to be absolutely sure, a biopsy can be done.  I tend to biopsy if patient requests a biopsy, or if I am not sure, or if I am concerned about cancer.   Rarely- lichen sclerosus can be associated with vulva cancers.

The treatment for lichen is the use of a steroid cream- clobetasol – and comfort measures as mentioned above.   If you do not keep lichen under control you can end up losing the normal appearance down there.  In severe cases you can actually end up looking like Barbie – no identifiable genitals at all -just smooth nothing with nothing but a pinhole for urine.  See how the lips just join together, and you ‘smooth out’?  Just about closed over!

Hey girls–you either USE it or LOSE it!!!

lichen sclerosus

Now –here is one vulva that has closed over–and has a tiny pinhole for urine to escape.

links for lichen:

Mayo Clinic info on lichen

Fast facts about lichen

PICTURES:  WARNING!!

Early lichen of vulva

 

 

 

 

 

 

2 comments

  1. Hello. I just discovered your website, and already have learned so much – thank you..!
    I am a 59-year-old, post-menopausal mother of 4.
    I have been steadily acquiring knowledge of conditions that have annoyed me for decades, many of which I’d never “met”.
    Many of the conditions focus on the genital/perineal area, which has been rashy and uncomfortable my whole life. These conditions include, among others, lichen sclerosus, lichen planus, lupus erythematosus, vaginal atrophy, irritable bladder, and etc. As I take immunosuppressants, I am also susceptible to opportunistic infections, and have been treated for many, including yeast, fungus, staphylococcus, pseudomonas, etc.
    My words of wisdom: Find a good, available, responsive health care provider (eg: Dr. Sandland..!).
    Keep looking until you find someone you want on your team, as this could be a very-long-term relationship. My current MD has been my PCP for 20 years.
    Then come up with a treatment plan together, and heed it. Revise together as indicated.

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