URGENT - Itchy bits Update!

[ItchDrivingMeInsane]

So further to my thread of a few days ago, complaining that my GP put a menopausal woman already on HRT with clear symptoms of vagina atrophy on skin thinning extra strong hydrocortisone cream rather than topical oestrogen cream which causes less harm and would probably have resolved my discomfort, I just had a telephone appointment with an ‘advanced nurse practitioner’ who stated that I must have a further intimate examination before anything else will be prescribed and if I do not wish to have one, they can only refer me to a gynaecologist!

She stated that they need to see if the hydrocortisone has thinned the skin any further and made it any worse!

Also that me being in unnecessary discomfort for 12+ months waiting for a gynaecologist appointment was ‘out of their hands’.

So I am basically being forced into an unnecessary vaginal examination despite me clearly stating to the nurse that I had experienced trauma from CSA and topical oestrogen cream does not need an examination to be prescribed.

She also asked sarcastically if I was a medical person myself obviously not happy that I have done a bit of research on my symptoms.

I could not get Ovestin online as it was only coming up with estradiol cream for £55 which I can’t really afford as a can’t work due to being a carer to 2 disabled DC. DH works so we get little in the way of benefits to replace my wage and he just needed some work on his car as failed MOT.

I do actually get free prescriptions anyway as I have hypothyroidism (does not affect HRT) so thought I’d wait for the telephone consultation this AM and would get it that way!

Appointment is at 12.30. What shall I say? I am so angry! Down below is quite sore at the moment as itching got worse as well.

First thread below.

https://www.mumsnet.com/talk/am_i_being_unreasonable/5059260-to-be-absolutely-furious-at-bloody-incompetent-gp?page=6&reply=134750026

I was examined by my GP, for similar symptoms, before she prescribed me Vagifem pessaries. After the examination she referred me to gynaecology, who examined me again, and prescribed me hydrocortisone cream to use. I had to use it for 3 months initially and now just use it as and when I need to.

You’re quite rude about the Advanced Nurse Practitioner. They’re highly trained. DS2 is a charge nurse currently doing his masters in advanced practice. By the time he finishes he’ll have spent six years at university and god knows how many hours working in the hospital.

The doctor fucked up and now you're paying for it. Sounds like they are closing ranks at the surgery too.

This is not a good place to post though. People commenting don't know that NICE guidelines say it should be prescribed on symptoms alone so they are having a go at you which must make you feel worse.

Misogyny in the health service is alive and kicking. I didn't realise it myself until perimenopause. Anecdotally admittedly women in menopause are treated like shit. GP's mostly seem to know nothing about HRT and be totally disinterested in learning about it in my experience. So many women end up going private because they are not allowed to access a mainstream drug taken by millions of women.

@MonsieurSpade my apologies but you're not the OPs doctor or her medical professional, I totally agree with you that it should be prescribed. There has been a mistake from the first doctor not recording the VA on the notes.
However @ItchDrivingMeInsane as I said on your other post you really should check your online notes are correct and you would have spotted the first doctor missed the vital 'vaginal atrophy ' off your notes this probably would stop the need for this second examination. You are where you are and I hope you're able to get this sorted today and start using the cream.
Fwiw ive used and been prescribed every treatment going , the ovestin is okay but I do find I have to used the hydrocortisone sometimes , or I use the pessary as prescribed. I've also seen a dermatologist gynaecologist and she prescribed amitriptyline in a low does which again is helping.
Hope you get sorted soon

Sounds like you need to send an email of complaint OP.

The first doctor DID examine you if I remember rightly from the other thread but failed to make adequate notes?

They are being unnecessarily difficult. Funny how this happens to a disproportionate degree with women of a certain age.

But nurse practitioners are highly qualified and often know more than the doctors do.

I want to start by saying iv experienced CSA too so everything I’m about to say is with the slant of empathy and full understanding of the complexity of what an adult deals with after a trauma such as this.

I don’t actually think you should be forced into another examination but I don’t think you’re going to get out of the examination due to the possibility of the thinning skin. I think unless you decide to launch a full complaint regarding your treatment then you are going to have to a lot of work to prepare yourself for another examination but then hopefully you’ll get on the right treatment and you’ll feel much better.

BUT

i completely understand why this is not just difficult but that the idea is horrifying.
csa is something that infects every aspect of life.
there are so so many incidents where we think professionals should understand but they just have no concept of the magnitude of the damage that it has caused or the huge amount of energy and bravery it takes to push past the ramifications of the trauma to even seek out treatment or support before even reaching the point of getting any!
its not like any other type of trauma imo

you are not being difficult and you absolutely should be getting more understanding empathy and yes even a little flexibility to help you feel ok about next steps rather than what must feel like your an animal trapped in a corner. If you had had that you may have then felt strong and safe enough to manage this examination. Or even finding an alternative that works for you and the medical professional.

good luck @ItchDrivingMeInsane

you really should check your online notes are correct and you would have spotted the first doctor missed the vital 'vaginal atrophy ' off your notes

that assumes you have access. All I have access to (via the NHS app) is a list of medication.

And as for some of the people who have replied to this thread you should be ashamed of yourselves.

No need to mention cost
It's irrelevant
No need to mention being a carer
It's irrelevant
No need to put advance nurse practitioner in inverted comments.
That's rude. They'll be highly qualified.
Of course you'll need to be examined. Why would you not?
Speaking from experience my guess is lychen sclerosis and guess what the treatment is.....steroid cream that thins your skin.
How do i know? I was examined, diagnosed and treated. It's an ongoing condition
Have some respect for the medical professionals. They really do know what they're doing

I think many of these comments are quite harsh. Only you can decide what to do next.

With phone appointments it's so difficult to build a relationship, for trust to build and unfortunately it was never going to resolve the issue as they wanted an examination to take place.

It wasn't your place to check your notes were correct.

She WAS examined, and vaginal atrophy was noticed by the doctor but not written on her notes.
That's the issue.
No need to be so rude

Same here.

The nurse was doing her job with the information she had.

I've had the same problem as you, recently. Having had this as an ongoing issue and having had an examination before. They need to rule out lichen sclerosis and other issues.

Gp wanted to examine, so I went along and was examined. Why Not? They have more experience. It could be something else - they have to check things out.

Gp increased my vagifem.

I don't agree. I'm also a victim of csa but I wouldn't go on like this if I needed something to help me.

@Therealmetherealme @parkrun500club I agree we shouldn't have to check our notes the job should be done correctly in the first place , you have to advocate for yourself nowadays in order to get what need.
You are entitled to see your full notes you can ask your GP practice so authorise this so that you can see everything.

You can buy estradiol pessaries in pharmacies now

Ovestin is £20, you can buy it on line.

I was told I can’t have topical oestrogen gel as it’s ‘dangerous’ (exact words) when already on HRT gel. I use Oestrogel (upped to 3 pumps) on inner thighs and arms. The nurse did differentiate between me being on gel as opposed to patches or tablets for some reason which is surely absolute nonsense?!! She has noted on my note that doctor said it not safe.

Nurse said she’d checked with senior GP who’s in charge of medications.

I have an urgent referral to a gynaecologist (waiting time 20 weeks) because she said it could be a new case of lichen sclerosus despite GP saying at February appointment she didn’t think it was, no white patches or fissures and the noted presentation on NHS record is the same for both this and the previous appointment.

Bearing in mind I’ve been suffering for 6 months now constantly so you’d have thought it would have been more apparent.

Neither noted the atrophy on my notes.

In the meantime I should use Vaseline so no treatment even for the suspected lichen sclerosus.

It beggars belief.

Sounds utterly ridiculous @ItchDrivingMeInsane , so next steps , I would put in writing a complaint to the practice manager today and get an acknowledgement for this. Detail everything , did you question why the VA isn't on your notes , why wasn't it added today ?
You already have the treatment for suspected LS don't you so use it , in my experience it did help.
Go and buy the ovestin online it's available I know you'll have to pay but at least you'll have it.

I'm peri menopausal and plagued with itchy bits. I've found something that finally works, please don't laugh! A hot flannel with vinegar on it. After a few days of washing it with warm water and vinegar, the itchiness has gone!

I had suspected Lichen Sclerosis, which was why I was referred to Gynaecology. It turned out not to be, but they don’t give you treatment for it because they want the gynaecologist to see it before the treatment works iyswim. My GP told me not to use Vaseline because it aggravates it, I was recommended this by her.

OP I think the examination is the way forward. Not least because the steroid cream has added a complication to prescribing the gel.

From your more recent posts it sounds like the medical practitioners don’t think it’s a clear cut case of vaginal atrophy. Maybe the GP who didn’t note it thinks there is something else going on or some underlying cause/contributing factor.

You cannot expect medical professionals with years of training and experience to trust your Google research over their own opinion.

I understand why this is difficult but the GP who examines you is only interested in diagnosing and treating the right medical condition.

Mine was diagnosed with a biopsy.
I use dermovate ointment and it works really quickly
The itching just comes from nowhere! But it sorts it out pretty quickly

YANBU the initial treatment has caused further issues. I’d be angry too.
Unfortunately as we don’t have a penis we have to go through this.

So you’ll have to go through the exam, get the script/meds (hopefully they don’t mess that up) and feel better.

If you hadn’t posted in aibu you would have had better responses.

I think you're understandably conflating 2 issues together, for the cream itself, you don't need to be examined, but in order to check there hasn't been any further damage due to the steroid cream, you do. I'm sure they will be able to do it in a way that you are as comforts you can be with it, with your history, but hopefully this will be an end to it and you can have the treatement with is going to work. Good luck