Burning vulva/perineum - help!

[k80pie]

Burning vulva and perineum - been going on nearly a month - is this thrush?

Backstory-
-unusual discharge, swab positive for BV (UTI test clear)
-prescribed metronidazole, awful reaction after two doses (dizzy, insomnia, nausea, flat-feeling), stopped
-switched to clindamycin, took full course
-burning pain (vulva and around anus) began at some point along the way, not sure when

• prescribed thrush treatment (2% clotrimazole) even though no discharge

-more burning (even though applying clotrimazole for several more days to exterior), GP advised to wait before doing another swab given that I've been doing thrush treatment.

Now going away for a week with small children for a long planned trip - oh dear god help me - bringing 1% clotrimazole cream for applying externally, probiotics, and contemplating taking a fluconazole tablet.

Could this be thrush? I've read other threads that said they had burning around whole genital area like me. It's front, middle and back. No itching, no unusual discharge. Unlikely that I would need Ovestin so suddenly as this surely. On waitlist to see gynae when I get back in a week but so far next appointment is a month!

Anyone got any thoughts?

It’s not thread worms is it ?

You don’t say how old you are but sounds very like the vaginal/vulval/urinary effects of low oestrogen. Topical oestrogen is what you need. I think it took me four or five trips to the GP thinking I had a UTI before I started on the oestrogen. Totally transformative.

I tend to get sore rather than itchy with thrush. Clotrimizole alone doesn't usually clear it - I need a dose of fluconazole. But none of us can know from here what's going to work.

@lovelycattus Eek I don't know - I do have worming tablets at the ready for us all to take, but can't decide whether to take that or the fluconazole first!

@Hamserfan I'm 45 - so possible - but would it have come on so suddenly and persistently?

i remember this starting quite suddenly for me and stopping with topical and pessary oestrogen, no other menopause symptoms?

Oh yes it absolutely can feel like it's come on instantly. What I learned afterwards is that estrogen levels start to drop several years before. So id had a few years of sex feeling a bit painful on entry but ok afterwards & I just put it down to one of those things.

and then one day out of nowhere, the itching & burning started and it was horrendous. I thought thrush at first but nope. It was only researching on line that helped me identify what it was. Discussed with menopause nurse and was prescribed vagifem. It took several months to get back on even keel - now I use vagifem and yes VM.

luckily you can now buy topical estrogen over the counter & don't need a GP prescription

@k80pie for me it certainly did seem to happen quite quickly. I was mid 50s. Still having regular but scant periods after implant was removed. I guess levels had been dropping for a long time then just reached a tipping point.

Hmm thank you everyone, this is all very interesting. I did actually ask for some Ovestin but on the label it says it is for internal use only and I think I'll wait til I get proper instructions from the gynaecologist too before I try it as I heard it can also cause burning at first?!

Maybe I will take the fluconazole to try to knock any thrush out, continue with the cream during my trip, do a worming tablet, and then do a swab once I'm back to make 100% sure the BV is gone.... then gynae for an exam and ask about how to use ovestin

To those who found the oestrogen cream helped - did you have burning at the front and around the perineum/anus as well?! That is what made me think it was thrush and not atrophy...

I use Ovestin internally and externally. Basically it's the tissues & skin of your vagina & vulva needing estrogen to repair themselves.

Another good thing is hydromol - entirely water based & can be a good stop gap soother

Yes. Al the tissues around there will thin and tear with lack of estrogen. It's why UTI are much more common in women as we get older. A GP I work with has said to me she thinks women should just be prescribed it as standard to prevent the UTI & bladder weakness she sees amongst much older women (75+)

the gift that keeps on giving 🤪

I would agree @Theeyeballsinthesky it should be issued automatically from perimenopause. I have had another bout of discomfort and three positive urine tests since June. Oestrogen pessaries and cream amounts doubled and am now at 10 days without symptoms 🤞

How are you now! I have unusual discharge - 43 - no signs of any infections and microbiome is high levels of lactobacillus so should be good. But it’s prickly and uncomfortable. I’ve tried vaginal oestrogen cream but probably only for about 6 weeks before giving up as it wasn’t getting any better. I’m lost with what to do next!

Hmm that is mysterious! Could you possibly try a worming tablet?!

My saga continues...I took a one-dose fluconazole tablet before going away, in case it was thrush, and the next day noticed white bits in my stool (so so sorry tmi), you might have been right @lovelycattus !!! So I freaked out and took a worming tablet the next night when we got to our destination. More white bits in days following and symptoms disappeared for four glorious days of our trip - only to return on the final day. So I am none the wiser about whether it was the fluconazole (thrush med) or the mebendazole (worming med) that did it?! I have just been to the lab for a repeat swab (to check for thrush/bv) and bought more worming tablets in anticipation of taking another one this weekend (at the two-week mark). But I'm puzzled why the symptoms returned after only four days, surely thrush or worms (shudder) would not return so soon? Anyone able to enlighten me on whether that's possible?

I haven't tried the oestrogen cream yet but I have an appointment booked with my proper gynaecologist in three weeks....

I would have a read up about lichen sclerosis, just in case

I take cystitis powders when I get a flare up, and use sudocrem, so that acidic urine doesn’t ‘burn’ the sore area and make it worse. This helps!

Burning and intense itching ?
I get that

I would try a Juno bio or screen me test for your microbiome. Having said that mine came back with possible cv - too much good lactobacillus crispatus which can cause burning and thick discharge. Currently trying baking soda in the bath and capsules to see if I can lower the good stuff ironically

I think you’re supposed to take 2 doses of the worming stuff spaced out and all the family too and 60’C wash for towels and bedding too

Yes - I read it should be two weeks exactly - I’m counting down til Sunday and have enough for everyone! I suppose that means I have to wash all underwear and pj pants at 60 too, not really willing to shrink them all, have been washing with germ killing laundry rinse…🤞

In another twist my swab came back clear yesterday - good news, though some unusual discharge has returned this morning - I hope I did the swab properly. Such a saga, I can’t wait for this all to be over eventually!

Keeping 🤞for round 2 ovex and it kills all the eggs