Brief Answer:
You likely have a condition called Vulvodynia

Detailed Answer:
Pain around the vulva, called Vulvodynia, is a recognized gynecologic problem that can be difficult to treat. The diagnosis is made when tests for other common causes of vulvar pain, like infections and other skin diseases, have been ruled out. Examination by a gynecologist may reveal tender red spots at the vaginal opening, which is called vestibulitis. It is difficult to treat because no one really knows what causes it; and treatment is usually a trial-and-error process.

The first thing i usually recommend to my patients with Vulvodynia is to remove any potential irritants from the vulvar and vaginal area. So you should switch to perfume-and-dye free detergent for your laundry, always wear cotton underwear with no liners or pads (many people have skin reactions to Always products) and do not wash your vulva with anything other than mild soap with minimal fragrance. Applying a waterproof barrier (like Vaseline) to your vaginal and urinary opening can help moisturize the area and decrease the burning sensation, whatever the cause. In addition, acidic and spicy foods tend to make vulvodynia worse, so avoiding tomatoes, peppers (especially spicy ones), citrus fruits and other acidic foods can sometimes help.

People have used steroid creams, creams for burns (like Silvadene), estrogen cream and others for treatment of vulvar pain. Different ones work for different people. I try to use just a gentle fragrance-free lubricant like Vaseline at first, then trying a steroid cream (like over-the-counter Hydrocortisone cream) before resorting to other treatments.

So in summary, I would try to make your laundry, home and bath products as fragrance, XXXXXXX and irritant free as possible. Try Vaseline to soothe the area and if none of these work I would considering consulting with a gynecologic specialist in pelvic and vulvar pain. A type of gynecologist called a urogynecologist is also a good choice.

I hope that I was able to adequately answer your question today and that my advice was helpful. Please do not hesitate to contact me if I can be of any further assistance.

Best wishes,

Dr. Brown

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Brief Answer:
The symptoms you describe are not consistent with herpes

Detailed Answer:
Hello again,

You are correct that exposure to genital herpes can be tested by blood even if you don't have a sore to culture. However, herpes presents with very obvious sores that tend to come back in the same area over and over. It does not cause overall burning in the vulva and also herpes outbreaks go away on their own after a week or two. Your symptoms really are not consistent with herpes.

Regarding probiotics, the ones that help the most are live cultures, like those in yogurt. Probiotic pills are dried and there is no evidence that they are able to replenish your normal flora. Acidophilous is the main kind of healthy bacteria present in the vagina and it is used to culture Kefir and other kinds of yogurt.

Staph and Ureaplasma do not usually cause symptoms in the vagina, but rather are present in infections caused by other organisms as a second pathogen. Staph is also unusual in the vagina of adults. So I also doubt that a vaginal bacterial infection caused your symptoms. You were treated with the doxycycline anyway so i am sure these bacteria are currently gone, but they may not have been the problem in the first place.

I really do think you have a condition of your vulva rather than an infection. You may find this webpage helpful: http://www.nva.org/what-is-vulvodynia/

In the meantime, I really recommend you try to remove all potential irritants that may come into contact with your vulva (including in the foods you eat) and try Vaseline or another vaginal moisturizer (NOT Vagisil- it is a terrible product).

There are many university medical centers in South Florida and I am sure you will be able to find a specialist.

I wish I could be more helpful, and i sincerely hope you find a solution to your situation, but i hope these suggestions at least will give you some relief.

Let me know if I can be of any further assistance.

Take care,

Dr. Brown

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