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[Elissa]

Hi ladies, I have been reading through this forum and I'm hoping you can help.  I'm 41 and very distressed by vulvar/perineum/anal area/inner thigh symptoms.  The areas go very red (rash) and they burn.  It's painful to walk around and sit down at times.  There has been a slight itch internally and externally but this is not a prominent feature, it's the tender, irritated, burning feeling that's the worst.  My GP reckons it's dermatitis and prescribed a topical corticosteroid called betamethasone cream 0.05%.  This helps calm it down and cured it twice in the past year but this time around my issue has been going on for 3 months and the cream is not getting rid.
My GP recently offered Ovestin (following my suggestion of vaginal dryness) but I'm not convinced she thinks it'll help.  I have completed the 2 week loading and now i'm on the twice weekly application (internally only).  I wouldn't say it's helped so far.
My history: heavy periods that simply wouldn't stop 2 years ago.  I was offered a mirena but wasn't keen on a device in there, so the gynaecologist put me on daily Provera (medroxyprogesterone acetate) 10mg daily.  I have not had a period since I started on these tablets.  My GP mentioned recently this was suppressing my estrogen so hence my suggestion that I might have vaginal dryness and she offered for me to try Ovestin.  I've been told a couple of times during pap smears that I am dry inside.
I'm not currently sexually active so don't have pain during sex.
No history of thrush, have been tested a few times internally and externally and it's always negative.
I have no urinary symptoms like cystitis or urgency.
No visible changes down there.

My questions to you please:
- the burning associated with vaginal atrophy (a lot of you mention) - is it on the vulva/perineum area or are you referring to an internal burn in the vagina/when you pee?
- do you think my symptoms (burning, red, irritated skin and occasional itchiness) is vulvar atrophy?

I'd really appreciate your thoughts.  Sorry for such a long post. Elissa 

[Minusminnie]

Because you mention a red rash and that the cream you used got rid of it before imho I’m not sure it’s va.

Do you wear cotton/breathable  underwear ? 
Have you looked at soap powder you are using or changed to washing pants with water or very little soap powder and rinsing really well ?
What shower gel or bath products are you using in the area ?
Do you ride a bike which could affect the perineum area ?

[Elissa]

Thanks for your reply minusminnie, really appreciate it.

Yes, I have also thought about irritants.  I initially (a year ago) felt that my first episode might've been caused by staying in sweaty gym clothes for too long before showering.  My first episode lasted about 5 weeks. It started off as itchiness then quickly became burning.  The steroid cream eventually fixed it up but it took a lot longer than the GP expected.  During that time I did a lot of research online and changed underwear to 100% cotton.  I tried to shower immediately after exercise and I was symptom free for several months.

My second episode was shorter (again treated by steroid cream).  No itch this time just a burning red rash and small cuts on the vulva.  I wasn't sure what caused it that time.

After many months of no symptoms I took a chance and didn't shower immediately after exercising in March and about a week later it started again and it has lasted 3 months this time.  I have stopped washing my hair in the shower so shampoo doesn't reach those parts, I have stopped using shower gel, only water.  I have changed to a sensitive laundry detergent but the symptoms persist.  They come and go and move around.  Sometimes it's the front area, then it's the back area.  Sometimes there's no redness but the skin rubs on clothing and I struggle to walk around.  I cannot exercise at all.

I am at my wits end.  Yesterday I went out and bought non-bleached toilet paper in the hope that regular white toilet paper has been causing all this.  I find it hard to believe one day without an immediate shower caused 3 months (and counting) of pain.  Trying to figure this out.  Appreciate any help you can offer.  It's not really something I can bring up with the other mums at school pick up!  Thank you.

[Minusminnie]

I’m so sorry it sounds like you have been trying everything.

The small cuts on the vulva you mention do indicate va.
Using estriol cream externally may help ie rubbing small amount on the vulva rather than just using internally.
I’d trial starting low & build up the frequency and amount to what you feel you need. It may take time to work as well.

Hopefully someone else will be along to comment on use of the Provera & if that is affecting things.

[Jules]

I also think you need to use the estriol externally.  Using it inside won't help the outside.  My friend had paper cuts and uses ovestin. I've recently had an episode of soreness and I'm sure mine started because I was sat on a high stool in jeans for 3 hours causing pressure on fragile skin. The ovestin will plump up the tissues but you need patience.  I'm using it nightly and a little in the mornings plus an internal pessary nightly.

[CLKD]

Most likely vaginal atrophy.   Get some appropriate medication, contact your Nurse Practitioner for a consult so that she can have a lookC.  As oestrogen levels drop so the body may become dry: inside and out - including the vaginal walls which become thin and sensitive.  The need2P can be constant as VA mimics repeated urine infection-type symptoms really really well.

In the mean time gently insert a mositorisor, I use KY Jelly successfully.  There are 'yes' and 'sylc' products too. 

   and let us know how you get on.  There are threads on 'bladder issues' as well as lots on VA!

[Minusminnie]

Elissa as a ps if you can bring yourself to talk to other mums at the school gate you may find a kindred soul & relieve some of the stress surrounding this. 
Any other body part would probably be talked about in conversation. 

[Emma]

Betamethasone is a corticosteroid that is primarily used to reduce inflammation and suppress immune responses. It is not typically used as a primary treatment for vaginal atrophy.

While betamethasone may provide some relief from inflammation if there are associated inflammatory conditions or severe irritation, it does not address the underlying cause of vaginal atrophy, which is estrogen deficiency. Therefore, it is not considered a primary or effective treatment for this condition.

[Elissa]

Thank you for all the replies.  I will consider ovestin on the outside.  I did wonder how applying it internally would help with all my external symptoms!

Thanks Emma, I'm still using the betamethasone cream as I couldn't imagine not doing anything to help in the meantime, too painful!  The GP said use it 'as needed' while I try Ovestin.  Not keen though as I read reviews about how it can thin the skin etc.  Maybe the ovestin might kick in and I can get rid of the cream...if I have VA that is...

Can I ask if any of you get a sore rash down there as part of VA?  Have any of you ever had a diagnosis of dermatitis when it was actually VA?

Thanks again.

[Jules]

I couldn't see because it was just inside but my GP said the sore area was quite red. Not a rash I don't think. The steroid cream started working fairly quickly.

[CLKD]

we can use VA treatment every night if required, regardless of what the info in the leaflet suggests or what GPs tell us: many are scared that women can overdose on VA treatments 

[Ayesha]

Thank you for all the replies.  I will consider ovestin on the outside.  I did wonder how applying it internally would help with all my external symptoms!

Can I ask if any of you get a sore rash down there as part of VA?  Have any of you ever had a diagnosis of dermatitis when it was actually VA?

Thanks again.

It can be both I'm afraid, what I call the double whammy, and makes your condition more complicated to treat and the time it takes to heal.
You have a great GP who has given you the meds required, use them as prescribed. The oestrogen will make the tissues stronger but again that takes time, its patience but you will get there.

[Jules]

we can use VA treatment every night if required, regardless of what the info in the leaflet suggests or what GPs tell us: many are scared that women can overdose on VA treatments 

It's not necessarily a fear of overdose, its that different bodies react differently to it as mine has done after a few months. I have had breast pain quite bad last time and a bleed. Some GPs might be overcautious but many are not

[Ayesha]

Agree, Jules. Also Elissa's condition is more complicated than just Vaginal Atrophy (GSM)
She must take the advice of her GP.

[Elissa]

Hi again, thanks for the replies.  I've found the information really useful so thank you. 

I agree Ayesha, the term GSM covers my symptoms more for sure.  I have been doing a lot of reading online and I'm finding more and more references to irritation and pain in the vulva/perineum and 'back' area which matches my experience.

Jules, yes redness is a much better description as it's not really a rash I have.  I am also red inside (from what I can see with much difficulty!).

Still feeling uncomfortable especially around my buttocks and inner thighs.  It feels like chafing and hurts so much when my clothes rub on my skin - feels like friction burn.  I have started moisturising these areas (E45 and vaseline) and have noticed a slight improvement.  It honestly feels everywhere 'hips down' has dried out all of a sudden.  Maybe not VA related, I'm not sure?!

I'll persevere with the Ovestin as prescribed and then revisit the GP in a few weeks.  I've noticed i'm definitely using less of the steroid cream so maybe something's changing.  Assuming the Ovestin helps, I'll be interested to see if the GP will recommend coming off Provera and maybe trying a Mirena.  I've read online the VA is a side effect of Provera.  Pity as it completely stopped my bleeding and I don't want to become anemic again. 

I'll also ask her to examine me.  She's only been looking at my outside bits for the last year (pap smear where she commented on my dryness was before these symptoms).  I'm actually surprised she gave me Ovestin without a quick check.

Will definitely come back and update this thread for others who might be experiencing the same symptoms. 

Thanks again