Brief Answer:
You may benefit from estrogen cream or a topical moisturizer

Detailed Answer:
Hello, and I hope I can help you today.

I am sorry that you have been having chronic itching of your vulvar area. I am sure at this point that it is not due to a yeast infection, as you have taken Diflucan with no relief. I am also sure your skin must be quite raw and irritated if you are seeing blood on your toilet tissue. Without being able to examine you or knowing your complete medical history it may not be possible to make an accurate diagnosis, but i can give you some suggestions of how you may feel better.

First, you should make sure there is nothing irritating in the products you use on and near your vagina, so use mild and fragrance-free soap, toilet paper, laundry detergent, and try to wear cotton or cotton-lined undergarments.

Secondly, instead of using medical treatments, I suggest you try applying plain Vaseline petroleum jelly to your vaginal opening, labia and surrounding skin at least twice daily as a moisturizer and after you finish wiping in the bathroom. After menopause the skin of the vagina and vulva can get thin and dry which can cause it to itch. In addition, your gynecologist can prescribe cream that contains estrogen (unless you have had breast or another type of female cancer) to apply externally that will help the skin get thicker and be able to moisturize itself better, which also can improve the itching. Steroid creams will help with skin irritation and itching in general, but prolonged use of them can make the skin even more delicate and irritated.

Lastly, i want to make sure you have had an evaluation and pelvic examination by a gynecologist to make sure that you so not have a genital skin disorder that is causing the itching. Rarely, vulvar cancer can present as an itchy patch of skin that never heals, so i want to make sure a GYN doctor has at least looked at the area in the last year or so to make sure the itching isn't from anything dangerous, and also to make an accurate diagnosis.

So in summary, I would need to physically examine your vagina in order to make an accurate diagnosis, but trying Vaseline and/or estrogen cream will hopefully improve the itching so you can be more comfortable in the meantime.

I hope I was able to adequately answer your question today and that my advice was helpful. Please do not hesitate to contact me if you need anything further, and if you do, please include a bit of your medical and gynecologic history as it may help me give you more specific advice about your situation.

Otherwise, best wishes and i hope you feel better,

Dr. Brown

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