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Suggest treatment for urethral caruncle

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Posted on Tue, 10 May 2016
Question: I have trouble standing, sitting and peeing brings lymph pain up my side and down my arms. I took a pric of what was going on 'down there', there is a urethral caruncle but the vestibule and into the vagina is full of growths. I am assured by my MDs these are not STD in origin but he has no idea. I have rectocele and cystocele. I have had 6 surgeries to remove tumours and cysts caused by hormonal imbalance due to exogenous steroid usage. I had a full hysterectomy at 26, I am now 52. My HRT use is spotty -- this was during the times when there was much fear and I had no symptoms of menopause that could not be handled with black cohosh, etc. Now I am growing monsters down there, it looks terrible and they are spreading up and inward. There is no discoloration, no discharge, just pain. I have difficulty evacuating my bowel and have to sometimes push on my perineum. I have had an enflamed pouch of XXXXXXX but my entero scopes (top and tail) have been clear. I have atopy which is severe. My CD57 is 21, my exogenous steroid usage created cushings and the length of usage caused my neurotransmitter reception to be spotty which creates a dual addisons and cushings state. I also have severely low BP (dips to 60s/40s but steady at 90/60). I know this sounds like a lot, I just want to know what these things are down there. They cause so much pain that I wrap a robax heat pack in a hankie as a pad down there. I have been minimally sexually active -- going years without. I had sex recently and that is when we decided to have a peak at what was going on. I have been married 27 years and there are no STDs. I wish I could post a pic, the growths are growing and going deeper into the vault. I can find nothing on the Internet searches that remotely looks like this. These are not gland issues but growths on growths, the caruncle is the most painful everyday. I am 52 and there is a 4 month waiting list to even get a gyno appt date. I'm scared it is cancer.
doctor
Answered by Dr. Jacqueline Brown (56 minutes later)
Brief Answer:
Those bumps you see are the remnants of your hymen and you have no caruncle

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

First, I want to thank you for uploading a photo, because it is very difficult to diagnose you properly without it.

I know you have had a long GYN history and a lot of medical problems, and I do not think I will be able to contribute much about your low blood pressure and your endocrine problems, but I can reassure you about what you are looking at on your perineum. I examined your uploaded photo and at least I can diagnose and reassure you about the appearance of your vulva.

First, the "growths" you describe are just the remnants of your hymen at the opening of your vagina. They appear enlarged because you have some level of vaginal prolapse and your vaginal opening may be more gaping from that. I can provide a link to a Google image that may be helpful to you.

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiKsvW786LLAhWK5yYKHSBcB-oQjRwIBw&url=http%3A%2F%2Fthemidwifeisin.com%2Fpost%2F0000%2Fi-think-that-i-might-have-a-polyp-in-my-uterus-i&psig=AFQjCNECUprICXPixY_Nqex6IO1QGTWTwQ&ust=0000

Most women who look with a mirror between their legs are alarmed by what they see, and I hope that the illustration I referenced is helpful to you.

Secondly, at least on the photo you provided, you do not appear to have a urethral caruncle. Urethral caruncle is most common in elderly postmenopausal women and is characterized by a dark cherry red spot poking out of the external urethra. It is normally treated with topical estrogen cream. Unless yours has already been treated, all i see is some swollen skin around the urethral opening. I will attach another link to a good picture https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjTyPCz9aLLAhXIOCYKHamsDvMQjRwIBw&url=http%3A%2F%2Fescholarship.org%2Fuc%2Fitem%2F0zw0j0hz&psig=AFQjCNFu_Fz2OHq1nvIE_uHZzJNVgsuNPQ&ust=0000. Interestingly, that picture was taken in a patient who had a history of longtime steroid treatment.

So I first want to reassure you that this is definitely not cancer or anything dangerous. If you have severe burning at your urinary opening I would start by

I personally think that your rectocele and cystocele are pushing the normal skin of your vagina and urethra out and those areas are swollen because they are chronically irritated. You may also have some atrophic changes (thinning of vaginal skin) in this area as well, and I think that using a topical estrogen cream will really help. In the meantime, applying petroleum jelly as a moisturizer to the urethra and vaginal opening will help lubricate it, but ultimately, especially if you need to push inside your vagina to defecate, you may benefit from surgery to correct the cytocele and rectocele. In this type of operation the vaginal opening is also tightened somewhat, which will restore your hymenal ring to it's proper location inside the vagina.

So again, I want to reassure you that nothing you have seen on your vulva is a growth of any kind, rather, it is severe swelling and prolapse of the normal tissue. By protecting your skin with Vaseline (petroleum jelly) it may decrease the burning with urination and pressure you feel. You should have a urine culture done to rule out infection, but I am sure your medical doctors have already done so. You really need to see an experienced OBGYN to get proper treatment, preferably one who has experience with urogynecology.

I hope I was able to adequately answer your question today, and that this information was helpful to you. Please do not hesitate to contact me if you need any further assistance.

Best wishes,

Dr. Brown
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Jacqueline Brown

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Practicing since :1996

Answered : 1425 Questions

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Suggest treatment for urethral caruncle

Brief Answer: Those bumps you see are the remnants of your hymen and you have no caruncle Detailed Answer: Hello, and i hope I can help you today. First, I want to thank you for uploading a photo, because it is very difficult to diagnose you properly without it. I know you have had a long GYN history and a lot of medical problems, and I do not think I will be able to contribute much about your low blood pressure and your endocrine problems, but I can reassure you about what you are looking at on your perineum. I examined your uploaded photo and at least I can diagnose and reassure you about the appearance of your vulva. First, the "growths" you describe are just the remnants of your hymen at the opening of your vagina. They appear enlarged because you have some level of vaginal prolapse and your vaginal opening may be more gaping from that. I can provide a link to a Google image that may be helpful to you. https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiKsvW786LLAhWK5yYKHSBcB-oQjRwIBw&url=http%3A%2F%2Fthemidwifeisin.com%2Fpost%2F0000%2Fi-think-that-i-might-have-a-polyp-in-my-uterus-i&psig=AFQjCNECUprICXPixY_Nqex6IO1QGTWTwQ&ust=0000 Most women who look with a mirror between their legs are alarmed by what they see, and I hope that the illustration I referenced is helpful to you. Secondly, at least on the photo you provided, you do not appear to have a urethral caruncle. Urethral caruncle is most common in elderly postmenopausal women and is characterized by a dark cherry red spot poking out of the external urethra. It is normally treated with topical estrogen cream. Unless yours has already been treated, all i see is some swollen skin around the urethral opening. I will attach another link to a good picture https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjTyPCz9aLLAhXIOCYKHamsDvMQjRwIBw&url=http%3A%2F%2Fescholarship.org%2Fuc%2Fitem%2F0zw0j0hz&psig=AFQjCNFu_Fz2OHq1nvIE_uHZzJNVgsuNPQ&ust=0000. Interestingly, that picture was taken in a patient who had a history of longtime steroid treatment. So I first want to reassure you that this is definitely not cancer or anything dangerous. If you have severe burning at your urinary opening I would start by I personally think that your rectocele and cystocele are pushing the normal skin of your vagina and urethra out and those areas are swollen because they are chronically irritated. You may also have some atrophic changes (thinning of vaginal skin) in this area as well, and I think that using a topical estrogen cream will really help. In the meantime, applying petroleum jelly as a moisturizer to the urethra and vaginal opening will help lubricate it, but ultimately, especially if you need to push inside your vagina to defecate, you may benefit from surgery to correct the cytocele and rectocele. In this type of operation the vaginal opening is also tightened somewhat, which will restore your hymenal ring to it's proper location inside the vagina. So again, I want to reassure you that nothing you have seen on your vulva is a growth of any kind, rather, it is severe swelling and prolapse of the normal tissue. By protecting your skin with Vaseline (petroleum jelly) it may decrease the burning with urination and pressure you feel. You should have a urine culture done to rule out infection, but I am sure your medical doctors have already done so. You really need to see an experienced OBGYN to get proper treatment, preferably one who has experience with urogynecology. I hope I was able to adequately answer your question today, and that this information was helpful to you. Please do not hesitate to contact me if you need any further assistance. Best wishes, Dr. Brown