Intimate examination required for HRT

@Delphiniumandlupins Yes, the current thinking is that LS is under diagnosed and not a "rare" disease. And it often doesn't present with the classic symptoms you see online.

I'm definitely not implying that the OP has LS! I do think there is more awareness among doctors/nurses now though ( hence wanting to rule it out).

To be fair to the nurse, she's probably not desperate to carry out intimate exams on patients on a whim and is only wanting to do this because it's best practice, which is in your best interests as the patient.

It's a faff and the sort of thing I'd want to be mentally prepared for, so if it was me I'd make another appointment with her and go back.

I have a friend who is very unhappy that her Lichen Sclerosis remained undiagnosed for several years. I had never heard of it before and know many women of similar age are also ignorant. My friend is being quite vocal trying to educate everyone she knows. I can understand the practice nurse wanting to rule it out before prescribing.

The nurse probably wants to check for lichen sclerosis, but if you're certain that you dont have that then I can't see that she needs to examine you

I'm not sure you can be certain you don't have something if you haven't been examined. The problem with vaginal atrophy is that it shares the same symptoms as about a dozen other conditions (most of which become more common in middle age).

If the diagnosis was made with out an examination I can see why she might be hesitant to continue prescribing.

Anecdotally, I have a friend who specializes in gyno/urinary diseases and she sees patients who present with very advanced LS who either didn't have a clue anything was amiss or dismissed their symptoms as chronic thrush or atrophy. It does happen.

I'd just book an appointment with a gp, I've found them to be more practical prescribing hrt. The nurse probably wants to check for lichen sclerosis, but if you're certain that you dont have that then I can't see that she needs to examine you. I just asked for cream and was given it no questions asked by the gp.

As someone else has said you can buy it online if you're desperate.

I wonder if they don’t have a record of it being confirmed as vaginal atrophy? And maybe need to be sure you are being treated correctly? I’m having horrors at the moment and am so sick of people fiddling with my fanny so I hear you.

I had a quick look online and can’t see any reference to an internal being required to rule out other conditions. Perhaps that particular nurse has had a previous experience of missing the condition she was thinking of and is now extra cautious? If so she should have explained this and offered you the option.

You don’t have to complain, how about asking for a second opinion at your surgery? An email would probably be sufficient. You can also buy products OTC ( assuming you’re in the U.K.) and bypass the surgery altogether.

There's a few possibilities but no one can be made to prescribe a medication they're not happy to.

• Nurse might not have been a prescriber and instead working from a PGD which could have required said examination for the medication to be issued?

Or it might have been the nurse has been involved in a complaint/case where examination wasn't undertaken leading to a missed/incorrect diagnosis and now they're extra cautious and wanting to physically confirm certain things before prescribing.

That sounds very odd. I have been prescribed the pessaries for 8 years and have never been examined since the first exam to diagnose vaginal atrophy.