Vulval atrophy?

[FloellaDaVille]

I’m quite sore and have little cuts that sting when I have a wee. Am looking for recommendations of cream that might help. I bought a Vagisil anti itch cream but it burns going on.
I'm on HRT patches and vaginal oestrogen 2x weekly and have been for 4 ish years.
Can anyone recommend anything to try.

I was told by my GP to return to using vaginal estriol 3/4 times a weak til the vulva ‘improve’. Also prescribed Replens to use on other days. And to use no other products when bathing/showering except Epimax ointment.
I also found Vagisil irritating. This was advice to me. It may not be appropriate for you.

Week! Not weak-iPhone knows best.

Are you scratching? What is causing the cuts? See your doc is best surely?

Could you not use the cream more? Some people use it everyday.
Alternatively you could try something like intrarosa (daily vaginal dhea than converts to oestrogen and androgens) which uses a coconut oil base and is very soothing.

When you say vaginal oestrogen do you mean the little pills you insert or a cream like Ovestin? If it's the pill then you need the cream as well and this can be used several times a week on the vulval area to keep things moist.
Also have a look at Lichen Sclerosis, this is a surprisingly common condition that many GPs aren't particularly aware of but is often mistaken for atrophy. It's treated with a steroid cream like Dermovate applied during flare ups.

Make sure you have an accurate diagnosis, then if it is atrophy, what works for me is Vagifem (topical oestrogen) pessaries - at first you do a loading dose of every day for 2 weeks, then you can cut down (but TBH there's no risk to continuing with every day if you need it). 2X week Vaginal pessary was not enough for me, even though that's what many GPs advise.

I use 4 x/ week.

I also use estriol cream (also low dose topical oestrogen) on the vulva and clitoris.

I am also on systemic HRT and had been for 4 years before the atrophy suddenly got worse and became apparent very to me.

IMO don't faff around with non-hormonal lubricants alone, except for sex. What your undercarriage needs, if it IS atrophy, is oestrogen

I wonder if anyone who has experienced this so severely that sex has been impossible has managed to come back from that to having normal sex? I've been in the OPs position for a couple of years now and have pretty much given up on ever being comfortable enough to contemplate sex again. Is it possible and how did you do it please?

@Itsbeenonmymind
I'm building up to it very slowly - started by making sure my vagina and vulva are as comfortable as possible, masturbating, and have just started taking testosterone as my libido has fallen off a cliff. Nothing happening so far (3 weeks). There's such a mix of mind and body, and if you've had a very painful experience, a degree of trauma. Luckily my DH is caring and patient.

Try using emollient ointment on the vulva. It’s thick and protective against friction and protects against irritants and should help the skin splits. It can be applied as often as needed and can also be used to wash the vulva with. Brand names include Epaderm, Hydromol and Epimax and generally contain only 3 ingredients. It’s sold in a tub and easily obtainable from pharmacies like Superdrug and online. https://www.nhs.uk/tests-and-treatments/emollients/

As others have mentioned if your topical oestrogen is the pesssary like Vagifem, you might want to discuss an oestrogen cream with your doctor that you can apply externally on the vulva.

You could also look at reducing other causes of irritation like tight clothing, toilet paper containing bleach / perfume and any other products touching the area.

Yes, it’s possible with effective treatment and giving it time to improve the tissue. It might though be a case of normal sex being a new normal in that it’s slower and more gentle rather than fast and hard so to speak.
Note that effective treatment depends on what the symptoms are. For example some women find the vagina canal shortens and narrows which dilators or toys can help with though again take time and perseverance.
The 6 o’clock position at the vaginal entrance can often be a particular sore spot where concentrating oestrogen cream and massaging it gently into the tissue can help.
Effective treatment besides topical oestrogen might include using it more frequently, trying different products, using moisturiser at other times. always using lube for sex and sometimes pelvic floor physio.

My GP said I couldn't have both the pessaries and cream (destroyed undercarriage thanks to lichen schlerosus). Will query this tomorrow!

OP your symptoms sound a bit like LS so may be worth checking.

How does lichen schlerosus get diagnosed? With a swab?

I think there is a lot of info online on this and maybe even a support group (or part of a support group.) It often needs a dermatologist to diagnose.

I did a lot of research online, had a good look down below and went to see my GP. She explamined me and agreed instantly that that's what it looked like but I had very obvious silvery patches of skin at that point. I have been using Vagifem, Ovestin and Dermovate on a regular basis for the last 7 yrs or so and manage to generally keep things from flaring badly or deteriorating further. The chance of seeing a dermatologist with experience of this condition on the nhs within a couple of years was unlikely so she was happy to treat and it has worked well. Dermovate doesn't thin vulval skin so I've had no side effects.

Thank you for the responses. I have done an e-consult this morning and will see what they suggest.

Hi op.

When mine got as bad as you, my gynae looked astounded when I said I was only using it twice a week. He told me to use of daily and liberally.

So I smother my vulva in oestrogen cream most day.

Mine was so bad it hurt to sit on my chair at work. It's absolutely fine now.

@FloellaDaVille It's important to rule out LS as long term there is a very small chance of it becoming cancerous.

I agree that the NHS would be slow and you may have to pay to see a dermatologist privately if your GP can't help.

Have a look at info online about the condition and treatments.

@Doodledoggle - how long did it take to improve after more regular use of the cream?

Within a month of using it daily.

GP had cycled me through hydrocortisone etc and nothing touched it until I used enough oestrogen cream.

Its miraculous stuff. My GP increased my prescription so I get 4 tubes each time I get a prescription.

Thanks @Doodledoggle - that's good to know! I'm glad you are improved now.