Brief Answer:
The caruncle takes time to resolve- it can take even a month or more

Detailed Answer:
Hello, and I would be happy to address your concerns today.

Urethral caruncles are relatively common in menopausal women, and are caused by thinning of the skin around the urinary opening and in the upper vaginal entrance due to a lack of estrogen. The skin can get so thin and raw that it gets bruised (hence the purple color).

It is pretty uncommon to see a caruncle in a woman as young as you, however if you have been menopausal for a few years it is possible, especially if you never used hormone replacement. It is very easy to diagnose when the doctor is familiar with the appearance of the lesion, and if a urologist diagnosed you, I would be confident that you were not misdiagnosed.

Normally, urethral caruncles do not cause symptoms, but because you are so active, especially if you are cycling, the area can get bruised and irritated more easily. Many gynecologic problems on the vulva get worse from cycling.

Estrace cream is the correct treatment, but it can take a long time for the skin to get moister and thicker around the urethra... even up to a month. To help speed up the healing process, I would recommend using the Estrace daily for at least 2 weeks and then space out the treatment to three times a week.

As far as working out, I would avoid cycling in particular because even with padded shorts and a padded seat, cycling still puts pressure on the vulva. Wear loose-fitting clothing, and try not to wear underwear whenever possible. Regarding your uterine cramping with exercise, that is also common from decreased blood flow to the uterus while you are exercising. The cramping usually resolves when you rest, but taking the naproxen will help to prevent the cramping. There is no reason to have surgery for a urethral caruncle, as it will resolve on it's own, but realistically it can take even a month to 6 weeks to fully heal.

So I encourage you to be patient, and your symptoms really should get better, but it will take some time. If you desire, you can take a photo of your vaginal/urinary opening and submit it for me to review. If you have any further questions on the issue, please let me know.

You can review images of a caruncle on this link:

https://www.google.com/search?q=urethral+caruncle+picture&biw=1716&bih=830&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiNybuep7PQAhUC8IMKHRrEAMgQ_AUIBigB#imgrc=upNE0QmdsJlGRM%3A

I hope I was able to adequately answer your question today.

Best wishes,

Dr. Brown

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Brief Answer:
It is not clear from the image you supplied that that is a caruncle

Detailed Answer:
Hello again, and I apologize for the delayed reply.

I was able to review your uploaded photo; I appreciate your supplying it.

For one thing, your vaginal opening appears moist and the skin is well estrogenized, which leads away from the diagnosis of a urethral caruncle. Secondly, all I could see in that image is some reddening of a small portion of your hymenal ring... which is tissue that surrounds your vaginal opening. I actually can't see your urethra, but the whole appearance of your vulva is not of a menopausal women. So either the estrace cream is working well or you may have been improperly diagnosed.

I think there is a possibility that the swelling and redness in this area may just be from chafing from cycling and possibly some of the exercises you may do where there is friction between your legs. The chafing may also rub bacteria into your urethra which can predispose you to a UTI, which can give you a cramping sensation.

So the bottom line is the area, whether it is caused by a caruncle or by chafing and inflammation, needs time to heal. I agree with your physician in that you should do sitz baths to soothe the area and it cannot hurt to continue to apply the estrogen cream. However, I would consider purchasing an over-the-counter antibiotic ointment and applying that area in addition to the estrogen cream daily keeping that area lubricate is going to enable it to heal. In addition, I would definitely avoid cycling or any types of physical activity because chafing between your legs. I would also encourage you not to wear underwear under your exercise clothing- it will decrease chafing.

If your symptoms of not improved by next week I recommend following up with your gynecologist again, as a vaginally or urinary tract infection may also be contributing to your symptoms.

I hope that this additional information was helpful, and that you feel better soon.

Please let me know if you need anything further.

Regards,

Dr. Brown

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Brief Answer:
You can use bacitracin over-the-counter and Estrace at night

Detailed Answer:
Hello again,

The more I hear about your history and after my examination of the photograph you supplied, I doubt more and more that you actually have a urethral caruncle. I really do think that you chafed the outside of urethra from cycling. Plus, your vagina does not have the pale, dry appearance associated with menopausal skin changes. Many of my patients who cycle have ended up with boils, chafing, blockage of the Bartholin's glands at the opening of vagina and other problems, especially from spinning, as those bikes have particularly narrow and hard seats.

So I recommend that you purchase over-the-counter antibiotic ointment (not cream) apply it around urethra at least once daily and use the Estrace cream at night. Three times a week should be enough, as as I stated before, your vulva and vagina do not appear to have any atrophic menopausal skin changes.

As long as the area stays clean and you are putting any pressure on that area anymore, your symptoms really should resolve within a week or so if it is simply chafing.

Feel free to contact me again if this regimen does not improve your symptoms.

Take care,

Dr. Brown

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Brief Answer:
Thank you for your kind words.

Detailed Answer:
Hello again, and thank you for your kind words.

Well, even though cycling is the most common culprit, a seam of your exercise clothing could have just chafed you in some other way. And I agree with you that you do not appear to have any vulvovaginal atrophy. So I think this is more likely an injury than a caruncle.

If you have a cramping sensation when your feel the pain, the cramping is most likely referred as the same nerves that innervate the bladder and urethra also connect to the uterus and lower intestines.

So I would try to stay well hydrated, use the creams, and let it heal. Again if this does not heal within a week I would recommend following up with a local
urologist.

I hope you feel better soon,

Dr. Brown

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