Labial tears

[LovelyDonkey]

I am 50, am on full whack HRT (100 mg patches l, ovedtin vaginal cream and 300mg progesterone, currently taking rectally).

I have several tears, despite using all of this, and am getting rather desperate. I have yes vaginal gel but it's not great, any ideas/suggestions of a longer lasting lubricant I can use.

I have EDS which I think is a big factor, the last tear was from loo roll.

What are you using to wash with? Hydromol is great if you haven’t used that

just water though even the act of washing (with just my hand) has caused further tears

Are you on F book? There’s a large dedicated group on there with a file on treatments and moisturisers, the group is called Vaginal Atrophy.

Hmm no I'm not really but might see if I can have a look. Just trying to work out whether it's worth going back to my GP about (who I already take up a disproportionate amount of their time) or if it's something I'll just have to try and sort myself

How often are you using Ovestin?
You may need to increase it to every day to get on top of this. Are you using the cream on the tears and not just internally?
You need a good pea sized dollop daily to manage tearing.

Yes I'm using it every night with the rest of the HRT, I've switched myself to using the utrogestan rectally as vaginally was causing an irritation which made so itchy I caused damage. Are there different strengths of vaginal oestrogen?

Is it definitely hormonal?
it sounds like lichen sclerosis, which can be aggravated by peri/menopause but not caused by it, and the treatment is different.

There is nothing stronger than 0.1% which is what Ovestin (now generic estriol) is.

Sorry to ask again but are you rubbing some in externally, not just using the applicator internally? You can apply a small amount on the actual cuts a couple of times a day.

It might be worth seeing a dermatologist who specialises in women's 'bits' because as PP says you might need a swab etc taking to make sure it's nothing else.

I have recently had biopsies and 4 surgeries for suspected Gynae cancer this year so at least 20 people have seen my foof, I would hope one of them might have noticed something!?

My eds really does affect my skin though, I've had melanoma so had multiple biopsies/ops and not one set of stitches has stayed closed. I just to walk around with a deep open wound on my face until it closed from the bottom up -twice. This took 4 months+ each time. The EDS has affected everything so much more since I've started the menopause

Ah, that makes a big difference, having already had tests.

Sorry- what is EDs?

Sorry Ehlers-Danlos, caused by faulty collagen. So skin is already more fragile and the drop in hormones just seems to be exacerbating it. I am not under a consultant for it but think I might join a charity as they have nurses, talking it through here is making me see it's likely that made worse by Meno.

The Gynae stuff was for womb lining/polyps/bleeding not external so maybe they don't look that carefully

This might be old fashioned or ill advised now, but the only thing that stops this happening for me is washing with Aqueous cream. If I use it I'm ok, if I just use water I'm not. It's really uncomfortable OP. I hope you solve it soon.

To answer your question yes I do think it is worth going back to your GP. Labial tears from washing yourself is not normal / expected and, if your GP is not knowledgeable enough to deal with it he should refer you to a specialist dermatologist / gynaecologist / EDS expert.

Presumably the tears are uncomfortable and painful and no woman should be expected to live like that. Plus you are only 50 so without treatment it could get progressively worse as you age. I would go back to the GP over and over until I got some treatment that seemed to be working. Good luck!

I'd add that there is likely to be a long waiting list for dermatology- in some areas it's 2 years! So unless you have been referred before and this could be a follow-up, you may need to consider privately.

Whatever route you choose, make sure the derma/ gynae knows about women's issues like yours- not all do and some specialise in other things.

I have Lichen Sclerosis with hardly any of the usual visible signs/damage. Just the intense itching and soreness. I have a very robust washing with Epimax/steroid cream routine. I also use a hormone pessary and cream too. I sympathise with you. I had tears as well before my diagnosis but mine were in my natal cleft (bum crack)

This

Thanks, I'll definely try and get in with GP. The worst tear is where the clit is attached, so is continually being rubbed by clothes etc.

Washing with an emollient such as Cetraben may help ease your discomfort whilst you’re trying to figure out what steps to take next. I use Vaseline during the day when I feel it’s needed. My dryness has helped with vaginal estrogen cream (I didn’t get on with the pessary) and I apply currently every second night as I’m quite new to this regime and it’s helping. I buy the softest toilet roll I can find to help with wiping. I hope you get sorted very quickly.

Lichen sclerosis needs a vulval dermatologist to diagnose it sometimes.

I have a mild, atypical form of it. I saw several gynaecologists before the dermatologist, none of them recognised it, but the dermatologist did straight away.

I also don't get itching, just a burning sensation.

Absolutely tons of hydromol reapplied several times a day helps. Use it as a barrier cream, it really help fissures.

Thanks, I went to the GP who took swabs and gave me antibiotics there and then as thought it looked infected. I'll raise a request for an appointment with the menopause specialist in the GP for her to have a look and advise what next. I didn't tolerate mirena and don't tolerate oral progesterone either so choices are severely limited. Hysterectomy only I think

Hmm - I've got no heard from the GP yet but my NHS app has been updated with:

Candida culture: no reference range
Laboratory comment: Isolated - see culture

That means they've found thrush doesn't it?

If so I really don't know what to do as it's the utrogestan that's causing it and the unbearable itching - but I've no other options :(

Does no reference range mean it's negative?

I also couldn’t tolerate progesterone orally and after a few months of taking it vaginally I started to get some flare ups/UTI feelings. I also was taking Vagifem pessaries alongside the progesterone and it all felt so uncomfortable. I went back to taking progesterone orally and although it made me queasy, I’ve overcome that and it settled after a couple of weeks. And I went on esteogen cream which works better for me. Can you use a combined HRT patch? It takes the bother out of using a separate progesterone.

I came off the combined patches as they were making me feel v low and triggering migraines which is diverging I've always had (tried mini pill/implant/depo jab). Weirdly mirena just made me feel flat and have no libido at all (not that I have much anyway) but the gynaes took me off due to cervix and bleeding issues plus recurrent polyps. It might be my only hope though (or just full hysterectomy).

I cannot take it orally as I have hiautus hernia and revient gastric ulcers and it makes things worse (my EDS is v sensitive to progesterone, pregnancy was a nightmare)

Re the results I think no reference ranges means there's no min-max values for Candida

Thanks for your help though

Just updating this in case it helps anyone else. The swab showed up heavy thrush and moderate staph, group b strep and e color (no BV though) so just finished antibiotics which have caused more thrush.

This is what happens every month from the vaginal progesterone/oestrogen so have a GP appt next month to discuss alternatives.

I am so glad the GP swabbed me though so they now have proof of what the pessaries do rather than thinking I'm just being 'awkward' (common in EDS as we tend to overreact to many drugs quite spectacularly, as per this)