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What Casues Vulvar Burning And Pain?
Question: I've had vulvar burning and pain for over a month now, it feels sore, raw, burning all over the vaginal entrance. At first i had a little bit of itchiness so i thought i had a yeast infection. I self medicated myself with over the counter yeast medications twice. Ive never had a yeast infection in my life so i did not know what the symptoms were. I did not have discharge, odor or , odor. After using the exterior cream that came with the monistat i experienced burning but i thought this was normal so i kept using it. It was then that i started to experience pain and burning. From there i started to experience throbbing pain only on the the lower bottom right side of the vulva area near the vaginal entrance not the labia, its that very fragile soft skin right before the vaginal entrance. The doctors noticed a white looking lesion on the area where it hurts the most. Looks as though I had put hot burning water there. Also my vaginal entrance looks inflammed, very red, and has a pearly whitish color to it as though i had put hot scolding water on it. I've seen 3 gynos, and 6 general practioners...no one can diagnose me.. I've been tested for all STD's, negative for yeast, negative for Clamydia, herpes, Ghanorrea, negative for HIV, siphyllis, negative for vaginitis, negative for trichomosis, negative for a UTI, i only tested positive for rare type B stephaloccocus. I had a vulvar biopsy where the pain originates 2 weeks ago and my results came back with "Papillomatous Hyperplasia non specific". Does this mean i have HPV? And can this be the cause of the burning / pain? Does HPV cause burning? Will i ever feel normal? I'm desperate as I have pain/ burning everyday all day. I cry from the pain. I cant sleep from the pain. I have been given creams of all sorts, Nystatin and Triamcinolone, clotrimazole and betamethasone, lidocane, and all types of antibiotics and no improvement, I have been treated for yeast, clamydia, ghonorea, and vaginitis even though those were negative. I now have oral thrush from all those unnecessary antibiotics. there an explanation for my suffering ? The pain and burning is so severe my anal area burns too. Is there a skin disease all my doctors are not detecting??? Please help!!!!! I dont know who to ask help for anymore ...please someone shed some light on my suffering
Brief Answer:
Possibility of Vulvodynia
Detailed Answer:
Hi. Thanks for posting your concern at HCM.
Going through your query, I could relate this type of presentation to few of my patients who practice over enthusiastic hygiene which might irritate the mucosa e.g repeated washing with soaps, using either dettol or savlon or tea tree oil for cleansing etc thus leading on to an irritant dermatitis which confuses both the patient as well as the clinician, as to what is the real cause?? without realising that the overaggressive hygiene that they practice is itself the cause.
General measures:
-Avoid repeated douching, soaps or body wash, in there. Instead you can use just plain water for gentle cleansing.
You don't seem to have any organic cause for the symptoms, vulvodynia is a definite possibility here.
Causes can be nerve irritation, hormonal changes, Allergies or irritation to chemicals or other substances, Hypersensitivity to yeast infections, Muscle spasms etc
Symptoms of vulvodynia usually begin suddenly and can last anywhere from months to years. Although the vulva usually appears normal, it may look a bit inflamed or swollen.
A burning pain is the single most common symptom of vulvodynia.
There is no specific treatment for vulvodynia, however, soaking in lukewarm or cool sitz baths may help.
Orally, Vit B12 in high doses e.g 1500 mcg per day for a month, may help.
Tricyclic antidepressants e.g Amitryptiline 25 mg once daily, increased to thrice daily if required, is also worth trying.
Anticonvulsants like carbamzepine 200 mg twice daily and gabapentin 300 mg once daily and increased to 300 mg thrice daily are other options.
Hope this helps
Regards
Possibility of Vulvodynia
Detailed Answer:
Hi. Thanks for posting your concern at HCM.
Going through your query, I could relate this type of presentation to few of my patients who practice over enthusiastic hygiene which might irritate the mucosa e.g repeated washing with soaps, using either dettol or savlon or tea tree oil for cleansing etc thus leading on to an irritant dermatitis which confuses both the patient as well as the clinician, as to what is the real cause?? without realising that the overaggressive hygiene that they practice is itself the cause.
General measures:
-Avoid repeated douching, soaps or body wash, in there. Instead you can use just plain water for gentle cleansing.
You don't seem to have any organic cause for the symptoms, vulvodynia is a definite possibility here.
Causes can be nerve irritation, hormonal changes, Allergies or irritation to chemicals or other substances, Hypersensitivity to yeast infections, Muscle spasms etc
Symptoms of vulvodynia usually begin suddenly and can last anywhere from months to years. Although the vulva usually appears normal, it may look a bit inflamed or swollen.
A burning pain is the single most common symptom of vulvodynia.
There is no specific treatment for vulvodynia, however, soaking in lukewarm or cool sitz baths may help.
Orally, Vit B12 in high doses e.g 1500 mcg per day for a month, may help.
Tricyclic antidepressants e.g Amitryptiline 25 mg once daily, increased to thrice daily if required, is also worth trying.
Anticonvulsants like carbamzepine 200 mg twice daily and gabapentin 300 mg once daily and increased to 300 mg thrice daily are other options.
Hope this helps
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have read about Vulvodyna...Why hasnt my Gynocologist suggest this? Can it be Lichen Sclerosis? Can it be Contact dermatitis? Psoriasis? Or Cirvicitis? Or perhaps im allergic to something? Are there tests to find out if im allergic to a specific product? In the past month i have not changed my soaps or my clothing, i have not changed my hygine practices either. A doctor prescribed Clobetasol propionate 0.05% ointment for lichen schlerosis but ive been too afraid to try it since all of the other ointments ive been given just seem to cause more pain and burning. Im waiting for my Pap smear results. I only wash my vaginal area with water now. Ive never experienced this much pain in my life. Its caused me to have depression. All i want to do is sleep. My Biopsy came result came back with "Benign Papillomatous Hyperplasia Non Specific" , is this a clear indication im positive for The Human Papilloma Virus? And if iam positive, can the virus be the cause of all my vaginal burning and pain? I have a follow up appointment with my Gyno soon. Im still in terrible agonizing pain. What questions should i ask? And is HPV the cause of all my pain?
Brief Answer:
Possibility of Vulvodynia
Detailed Answer:
Hi.
Lichen sclerosis is itchy and does'nt cause pain or burning sensation, neither does HPV infection. HPV is usually clinically obvious.
You said that, you had a whitish lesion on vulva, and on biopsy it came out as Benign papillomatous hyperplasia. This could very well be the reason for your symptoms.
A PAP smear is the next logical step in your case to look for any abnormal findings on cytology, even though the biopsy shows that the area sampled is benign.
Apart from this, I could not relate your symptoms with any of the possible diagnosis that you have inquired about or treated for, except for Vulvodynia. Any organic cause or lesion(s) responsible, if present, would obviously have been visible to your gynaecologist (6 of them).
Can you upload a picture?
Regards
Possibility of Vulvodynia
Detailed Answer:
Hi.
Lichen sclerosis is itchy and does'nt cause pain or burning sensation, neither does HPV infection. HPV is usually clinically obvious.
You said that, you had a whitish lesion on vulva, and on biopsy it came out as Benign papillomatous hyperplasia. This could very well be the reason for your symptoms.
A PAP smear is the next logical step in your case to look for any abnormal findings on cytology, even though the biopsy shows that the area sampled is benign.
Apart from this, I could not relate your symptoms with any of the possible diagnosis that you have inquired about or treated for, except for Vulvodynia. Any organic cause or lesion(s) responsible, if present, would obviously have been visible to your gynaecologist (6 of them).
Can you upload a picture?
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The area is too hidden to take a picture of...The finding was "Papillomatous Hyperplasia" exactly what does this mean? If HPV does not cause symptoms then how can this be the cause of my pain? Since HPV is a virus will my body try to heal the "Papillomatous Hyperplasia"? Is HPV a virus i have in my blood system or is it a localized disease? If my pap smear comes up nornal does this mean i dont or i do have HPV? Should i see a dermatologist instead of a Gynocologist? Would a dermatologist try to figure out the source of my pain, can i have an auto immune disease thats causing all this pain? I dont have bad odor or any discharge. My Vulva area and vaginal opening are very red, inflammed, sore and one just one area theres a constant throbbing pain...all the ointments i have gotten from several doctors have made my pain even worse. I dont know what my next step should be. Im really desperate. Should i look for a specialist? And what kind of specialist should i look for ? Thank you again doctor
Brief Answer:
Possibility of Vulvar Dystrophy to be ruled out
Detailed Answer:
Hi.
Well Vulvodynia is a diagnosis of exclusion. However, presence of a white lesion and biopsy finding of papillomatous hyperplasia, I would think of another possibility, that of Vulvar dystrophy. Papillomatous hyperplasia, does signify this change(dystrophy). It could be due to HPV. HPV is anyways a localized disease.
Vulvar dystrophy is a change in the skin of the vulva. This skin condition typically manifests as vulvar skin that is too thick or thin, often with white or gray discoloration.
Symptoms can vary from itching, burning, pain with sex, white or gray patch of thickened or thin skin on the vulva, redness or sores, stinging and irritation.
Any white lesion on vulva should be thoroughly investigated to rule out malignant changes. Therefore the need for PAP smear. I think you should wait for the PAP test result and then follow it up with a 'gynecology specialist".
Regards
Possibility of Vulvar Dystrophy to be ruled out
Detailed Answer:
Hi.
Well Vulvodynia is a diagnosis of exclusion. However, presence of a white lesion and biopsy finding of papillomatous hyperplasia, I would think of another possibility, that of Vulvar dystrophy. Papillomatous hyperplasia, does signify this change(dystrophy). It could be due to HPV. HPV is anyways a localized disease.
Vulvar dystrophy is a change in the skin of the vulva. This skin condition typically manifests as vulvar skin that is too thick or thin, often with white or gray discoloration.
Symptoms can vary from itching, burning, pain with sex, white or gray patch of thickened or thin skin on the vulva, redness or sores, stinging and irritation.
Any white lesion on vulva should be thoroughly investigated to rule out malignant changes. Therefore the need for PAP smear. I think you should wait for the PAP test result and then follow it up with a 'gynecology specialist".
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again doctor. I saw my Gyno again but she could not find anything. She wants to rule out Herpes by doing bloodwork. I had a swab test done on 7/9/14 for Herpes. I have been with the same partner for 4 months now. Ive had this burning/ pain for a month and two weeks now. I dont have sores or blisters. The Gyno only noticed a lot of inflammation and little raised "bumps" near the vulva but they are so small. They are not even big enough to have any fluid in them. The Herpes swab test came back Negative. The doctor took cell samples from the area where i have the most pain. I dont have painful sores or blisters. Why would my Gyno want a blood test for Herpes if i already tested negative and i dont have the symptoms? She is just scaring me. She thinks i might have type of dermatiti? Could i have herpes or dermatitis? Please help? s
Brief Answer:
Herpes
Detailed Answer:
Hi.
Herpes can easily be diagnosed clinically during an episode. Herpes, specially recurrent herpes is not very symptomatic and may even pass unnoticed. It presents as discrete, fluid filled vesicles Or erosions associated with pain or burning sensation.
Did she take the sample(swab) for culture Or microscopy?
The advantage of blood test for herpes (HSV ELISA) is that it remains positive for a long time after infection.
The major disadvantage of the culture is its high rate of false negatives. Because a culture works by requiring virus that is active, if a lesion is very small, or is already beginning to heal, there may not be enough virus present for an accurate culture. Moreover beyond 48 hours of the symptoms appearing, there is a risk of receiving a false negative test result. Viral culture is even less accurate during recurrences (positive in only about 30% of recurrent outbreaks).
Regards
Herpes
Detailed Answer:
Hi.
Herpes can easily be diagnosed clinically during an episode. Herpes, specially recurrent herpes is not very symptomatic and may even pass unnoticed. It presents as discrete, fluid filled vesicles Or erosions associated with pain or burning sensation.
Did she take the sample(swab) for culture Or microscopy?
The advantage of blood test for herpes (HSV ELISA) is that it remains positive for a long time after infection.
The major disadvantage of the culture is its high rate of false negatives. Because a culture works by requiring virus that is active, if a lesion is very small, or is already beginning to heal, there may not be enough virus present for an accurate culture. Moreover beyond 48 hours of the symptoms appearing, there is a risk of receiving a false negative test result. Viral culture is even less accurate during recurrences (positive in only about 30% of recurrent outbreaks).
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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