I'm really, really desperate with an embarrassing problem

[satinandsilk]

I am desperately hoping someone on here has some advice for a very embarrassing problem. Every since I had my little girl (natural delivery, 2nd degree tear) I have had horrendous itching down below. It is anal rather than vaginal, but affects the perineum. I don't have worms and I don't have a fungal infection. (I have had it swabbed. ) I desperately hoped it would 'just go away' but it didn't. After three months I saw a doctor, who couldn't see anything wrong. The misery continued and finally I plucked up courage to see a doctor again. Unfortunately she was very junior and very dismissive - kept going on about worms/thrush etc which I know isn't the problem and made me all the more miserable.
I can see tiny cracks in my perineum that sting sometimes; but they're not at all obvious, which is why the doctor probably couldn't see them. This problem is really beginning to ruin my life. I live in fear of the itching, which comes and goes, but is mostly there. There is no possibility of a sex life as I am terrified it will make the itching flare up. I have tried fucidin and other hydrocortisone creams, all to no avail. When my tear was stitched up, it was done by a very newly qualified nurse who took well over an hour and had to call for help. I can't help wondering if I was somehow stitched up too tight, and that has pulled the skin around my perineum. The junior doctor I saw dismissed this possibility. What can I do? I'm really really desperate.

I think you need another doctor and to get a referral to a gynae, explain that you can see tiny cracks in the skin, and that you have been swabbed etc and know it isn't worms or thrush. Stand your ground and speak up. Good luck, it sounds absolutely awful.

Get an appointment with another doctor and don't give up until you find someone who takes your problem seriously. You need to be very thick-skinned and persistent with the medics to make sure you get proper treatment, but a good one will listen to you, not dismiss your concerns. Ring today and start the ball rolling. Also I would consider trying something like Bepanthen, not to solve the problem, but for short-term relief. Good luck.

Yes to another doctor and push for a referral. If they try to fob you off with thrush/worms tell them that you have already been tested. I'm afraid it is a case of standing your ground and refusing to be fobbed off.

Good luck!

thanks everyone, i really am beginning to feel quite depressed. It's obviously i can't keep hoping it will go away by itself and will have to go back to the doctor. there is one of the partners at the surgery that i like and trust and i will get an appointment with her, even if it means a bit of a wait. i feel sure she'll take me seriously.

I'm sure there was something similar on embarrassing bodies (on C4) in the last year or so - from memory it was a man with anal itching for years, nothing 'wrong' (ie no worms etc), but it was to do with the cycle of itching and irritation that had been set up and breaking the cycle allowed the tissue to heal and problem was resolved. Am at work and can't find the episode now - but you might track it down & it will give some pointers?

Best of luck

Do you wear Panty Liners every day? You could be allergic to the formaldehyde they put in them (yes really - i mean why put that in - it's like bleach?) - Natracare do a good range of hypo-allergenic sanatary products.

I don't but the situation is definitely worse when i have my period. sanitary towels and panty liners aggravate the problem no end. I wear simple cotton underwear. (i can't believe they put formaldehyde in them...!)

Change your washing powder and use Surcare or soap nuts - do you use bio washing powder atm? And stop using fabric conditioner completely.

Use something very gentle in the bath/shower, I'd be tempted just to use aqueous cream for a month and see if that helps.

Any sanitary protection with 'plasticy' coating makes me itch like mad - it's awful. Definitely try a "Natural" range or mooncup/sponge/washable protection.

You don't use any female deodorant or scented baby wipe toilet wipes do you?

Also if the skin affected on your perineum is also scar tissue - you might be irritating the scar tissue when wiping with dry toilet paper. You have my sympathy, I occasionally have this problem and it is caused by the scar tissue (in my case). Also affected by liners/towels.

How long ago did you give birth?

Itis possibly low oestrogen levels- in older post meno women, itching is common and sorted out with oestrogen cream- prescription only though.

Asf for a referral to a gynae and maybe use these boards to find a good one who knows about post natal/vulval issues.

If you are near LOndon, Dr Wendy Reid is an expert in vulval stuff- at Royal free or privately.

I had a very similar sounding bout about 4 years ago, again swabbed and not diagnosed. In the end, i saw a different female doctor who diagnosed a type of excema (yes really!) and gave me a cream called Trimovate which is steroid, plus antibacterial. It worked very well. i have had the occasional flare up, but a week of the cream usually works.

It's awful, you have my sympathies.

Thanks everyone, much appreciated. I gave birth nine months ago but the problem started pretty soon after the birth and has never gone away for more than a couple of days maximum. I'm 37, never had this problem before having my daughter, so can't help feeling it must in some way be linked to scar tissue/the way i was stitched.

Could you have Lichen Sclerosus? If you think this is a possibility then take the info with you to see the GP. Treatment tends to be steroid creams(pretty strong ones, not just hydrocortisone). You can get referred to a specialist vulval dermatologist (this might be worth doing even if you don't have Lichen Sclerosus as they would have a better idea of what is wrong with you). However if your GP thinks that this might be your problem they will generally treat you themselves to begin with as it is relatively common. Also I would add that my dermatologist said that you can ignore the bits on websites that suggest a link to vulval cancer as this isn't thought to be the case anymore.

Have you ever been prescribed any creams/ointments for this problem?

Sorry to hijack this thread, but while you are on here, Breatheslowly, do you know much about Lichen Sclerosus? I'm waiting for a dematology appointment but that's not until December. Thanks.

I know as much as I have researched - what would you like to know? There is a Yahoo group for it (though I think most of the people on it are in the US) and at the bottom of the previous link I gave there is a link to the Royal College of Dermatologist's treatment guidelines which is a good place to start.

I have lichen simplex around the same area. Tips are:

Trimovate from the doctor
Do not scratch, even when it's driving you nuts.
Keep the area well moisturised. I nick my other half's double base emollient cream.
Perfume free shower gel
Shower rather than bathe
Cotton underwear
No underwear at home so the area can get a bit of air to it.

The above has made a massive difference to me.

Just some reassurance that it's not as scary as it sounds on most websites. I've done loads of research but the more I read, the more worried I get!

Satinandsilk, sorry for hijacking your thread. Hope you get some answers/relief soon.

Go to your GP and insist on a referral to a dermatologist who specialises in genito-urinary issues.
So many GPs dismiss feminie itching as thrush and fob you off with yet more canesten.

This is ruining your quality of life and you deserve better
Good Luck

Satin, i had the same problem years ago when i had my son. docs kept telling me its only thrush, went back and forth for about year and half, i tried everything , no underwear in house, every cream going , live yoghurt it ruled my life i was going crazy eventually got to see consultant and they said it was probably as result of ventoose? that i had, not sure how they did it but they used a speculum that had been frozen which burnt the top layer of skin off my cervix and that cured it , i thought that it was the outside skin that was the problem but it was internal Do not be put off by your doctors they have no idea what you are going through it rules your life and ruins the time you have with your baby, go back to doctors and ask for a referal to a consultant. you have my sympathy, mine went on for nearly 2 years before it was cured.

Mango - I don't think it is terrible, but it is something to be managed rather than cured completely. It is worth getting your thyroid function checked if you have it (my dermatologist insisted on this) as thyroid problems are more common in people with it. Also bear this in mind going forward as just because you haven't got a thyroid problem now, if you have thyroid type symptoms later it is worth being alert to the potential. I had my thyroid function rechecked when pregnant as it is a real problem for the developing baby if you have hypothyroidism.

LS is basically an autoimmune problem where your immune system attacks your vulval skin (and steroid calms it down). I seem to come from an "autoimmuny" family, so it is just one way of having an autoimmune disorder. I think that the key is to start with a very potent steroid ointment (I prefer these to creams and they have fewer ingredients) and then taper these down through less potent ones until you are not using any until a flare up or just a low dose a couple of times a week. The guidance suggests dermovate (called clob by Americans) but my dermatologist has got me on betnovate which isn't quite so potent and then tapering to eumovate.

With the benefit of hindsight, I wish I had a CS for my baby as I had very poor healing of my episiotomy and a flare up which I couldn't really use steriods for as the scar healing would have been affected. The poor healing was as a result of my LS and my dermatologist recommends that I have a CS for any future DC. CS for LS doesn't seem to be a standard recommendation, but I wouldn't take the risk with the type of birth I had. I had an induction & forceps (which are much more likely with induction). Had I really thought about it, I should considered the risks that inductions bring and said that the likely damage to my nethers was too high a risk to take. However no one seemed to notice LS in my notes and as it had been very little bother before, I didn't really think about it. I appreciate that you might have all your children already, but I would like this information out there, so that if anyone like me searches for it this comes up as I couldn't find anything myself about LS and birth other than "it'll be ok".

HTH

Thanks for the info, breatheslowly. It's reassuring to hear from personal experiences rather than googling on the net.

thanks for the new suggestions: will look into LS and also try to track down a private dermatologist who specilises in GU issues. In the last couple of days it's become worse than ever - the cracks are quite red and obvious now and it is pretty unbearable. i am definitely willing to pay to go private - would literally throw everything at sorting this out as soon as possible as it is spoiling my life.

It sounds to me like a fungal infection. I know you have had it swabbed and came back negative but fungal infections rarely show up on swab tests. The fact that it has been worse than ever over the past few days when it has been warmer ( i'm presuming u are in UK) would indicate a fungal infection. Fungi love to be warm dark and damp. Lots of fresh air, pure cooton underwear and try canestan AF cream, I know its for athletes foot but its the same tinea fungi that causes the itching.
Good luck