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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Exp 50 years

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What causes constant burning sensation in vagina?

Answered by
Dr.
Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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Posted on Mon, 28 Jul 2014 in Women's Health
Question: I am experiencing a constant burning sensation in my vagina. I have no discharge, no smell, skin is intact and appears normal, no frequency of urination, no burning sensation when I urinate, just this constant burning sensation that is coming from the inside. There is no visible inflammation or irritation. I did observe a milky white discharge briefly yesterday morning, which made me think it was a yeast infection, but it may have been normal discharge. I have had yeast infections in the past, and burning and skin irritation is always my main symptom. I am wondering if I am experiencing cervicitis, or a symptom of pelvic floor tension. I tested my vaginal ph using ph test strips by inserting a q-tip into my vagina and swiping the inner vaginal wall then applying it to the strip, which clearly read a ph of 3.5. I repeated this test again the following day and it was the same; 3.5.
doctor
Answered by Dr. Madhuri N Bagde 1 hour later
Brief Answer:
detailed answer below.

Detailed Answer:
Hello and welcome,
I am Dr Madhuri a consultant gynecologist and will be answering your queries.

It seems that you are having an infection in the vagina. This is the commonest cause of burning sensation and the history of a discharge also favors it.

There are many organisms that cause an vaginal infection and yeast is one of the commonest. But other causes like trichomonas and bacterial infections need to be ruled out.

The low ph is a good sign but it does not rule out infection.

Other reasons for burning sensation may be low hormonal levels seen with increasing age and also allergy to chemicals like talc or vaginal douches. Rarely leftover tampons can also sometimes remain deep inside the vagina and cause an infection and discharge. In this case however the discharge is copious and foul smelling. Your history does not suggest this.

So I suggest that you please get an evaluation from a gynecologist and then take treatment as per the cause. I would not suggest yogurt or any other remedy unless the cause is determined. Please do not insert anything inside as I do understand that the pain is not easily bearable and you applied the yogurt in an attempt to get relief. However use of vaginal tablest as per the doctors prescription would be a better alternative. The common drugs used are metronidazole and clotrimazole for mixed infections.

Regarding the thyroid, though I am not an expert on that, but a mild fluctuation is common and also depends upon the time of the day when the sample was collected. It is generally advised to get the TSH evaluated every 3 months so as to adjust the dose until a steady state is reached. So kindly discuss this with your specialist next time.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 18 hours later
Thank you for your response. I went to see an OBGYN today, who after examining me and looking at my swab sample under a microscope, said everything appeared normal. Since the burning sensation continues, she prescribed a topical nystatin-triamcinolone cream to apply to the outside twice daily x 7 days. I asked her if the antifungal aspect of the cream could create an imbalance in what appears to be a balanced flora and she said that it would not. I would like to know what your thoughts are on this, as I do not want to create a bacterial infection, or make matters any worse. I know the steroid helps to reduce pain by reducing inflammation, but she did not observe any inflammation either. She said that she can send the swab sample in to the lab for further testing, but thought that I should try the cream first, and if it helps with the burning that she didn't think it would be a necessary added cost. I appreciate your time and help!
doctor
Answered by Dr. Madhuri N Bagde 4 hours later
Brief Answer:
Welcome back

Detailed Answer:
Hello and welcome back,

I completely understand your concern. If there are no signs of infection and no organism is seen under the microscope I would prefer to use a plain steroid [for a short duration say 4-5 days] instead of using nystatin. It may alter the flora and predispose to another infection.

If it is negative then a syndrome called vulval vestibulitis syndrome or vulvodynia may be the cause. Nerve damage also causes a burning sensation and vitamin B 12 helps in such cases. You already have low folate so this may be a reason.

As of now I suggest that it would be better to use a plain steroid like triamcinolone and send the swab for further testing to rule out infection. Add vitamin B12 to your dose of vitamins. It takes a few days to weeks to show its effects. Meanwhile the swab results would be available.
Also if the pain is severe, local anesthetic preparations like lidocaine ointment or water based lubricants also are helpful in relieving the pain.

I understand the issue well and also your agony.
Hope this provides some help.
Take care and feel free for any further queries.
Dr Madhuri.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 34 hours later
Thank you for your kind and compassionate response! I called the OBGYN yesterday to request a plain steroid cream and to send the swab for further testing and was told that it was too late to send the swab in, as they were not in the office on Friday and it would be too late to send in on Monday. She also said that she felt the steroid/antifungal would offer relief and suggested I try it to see if it helps, and if it does not to return to her office on Monday. I soaked in an Epsom salt bath last night before going to bed and it seemed to provide a bit of relief, but I woke up to a continued burning sensation; yet, at current, it does not feel as intense. However, that does not mean it will not become worse (or better, hopefully) as the day goes on, as I have noticed that the intensity of burning does shift from more mild to more loud, so to speak. On 6/9/14, my B12 level was 416 (range 200-1100) and Folate 5.0 (borderline 3.4-5.4; normal >5.4). I took both B12 and Folate yesterday and will continue to take these supplements daily. Since the ph test strip reads a clear 3.5, do you think there is a possibility that I could be experiencing a vaginal environment that is too acidic, and thus causing the sensation of burning? Once again, I appreciate your time and help!
doctor
Answered by Dr. Madhuri N Bagde 20 hours later
Brief Answer:
Thanks for the appreciation.

Detailed Answer:
Hello and welcome back,

Vaginal environment is used to variable ph as it is acidic in some phase of the cycle and the ph ranges from between 3.5 to 4.5 with minor varability in a few women. So this is less likely to be the reason for burning. An acidic ph means that the normal vaginal bacteria are in abundance and so indicates a healthy vaginal environment.

I would not recommend trying too many remedies when the area is sore as it may increase the local irritation further. It is better to try an anti allergic tablet or syrup like benadryl if steroid ointment is not available to help decrease the allergic part. B12 and folate take a few days to a few weeks to show effect. Also if the pain is severe then local lignocaine may provide temporary relief but must be used after sensitivity testing.

Thanks for the appreciation. I would be happier still if you get relief from your symptoms.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 18 hours later
You are the kindest doctor, and I very much appreciate all of your time, help, and advice!

Since I have no visible signs of inflammation or irritation, and the burning sensation continues, I am starting to believe that my condition is due to pelvic floor dysfunction. My symptoms appear to be aggravated by sitting for long periods, such as when I drove my husband to the airport this morning and experienced increased lower back pain and vaginal burning when I returned.

Although my gut was telling me that the steroid/antifungal cream was not the correct remedy, in desperation, I applied it to each side of my labia twice yesterday (8 hrs apart) with no relief or reduction in symptoms whatsoever. So I have discontinued it.

Approximately 2 years ago, I suffered from coccydynia resulting from prolonged sitting. I began going to pilates and it helped, and my pain eventually went away and hasn't returned. However, after moving I stopped going to pilates and its been about a year.

I am thinking that I have some kind of nerve damage going on, as the burning sensation does feel nerve related; yet when I briefly brought this up with the OBGYN I saw last week, she felt it did not have to do with any pelvic floor disturbances.

Since I've been sitting at the computer for long stretches of time, I think it could very well be the cause. I have noticed a pattern that when I sit, it becomes worse, but when I'm walking around, although the burning pain is still there, it is not as severe. Yet I am also more distracted when I'm walking around and engaged in an activity, such as doing the dishes, so this may be why the burning sensation doesn't feel as strong. There are also times when I am walking and it feels like little pricks and pins are shooting through my labia, but it doesn't last long. It almost feels like I have tiny fissures in the labia when this happens, but I do not have any, nor do I have any visible inflammation. Moreover, upon internal exam at the OBGYN last Thursday, she did not observe any inflammation or irritation either.

I am thinking that my best option for diagnosis and relief is to visit a physical therapist that treats pelvic floor dysfunction in women. I would love to know what your thoughts are and if you have any experience with pelvic floor dysfunction and its resulting pain.

Thank you so much for your continued support and advice.

Many blessings unto you~***

XXXX
doctor
Answered by Dr. Madhuri N Bagde 45 minutes later
Brief Answer:
Thanks

Detailed Answer:
Hello and welcome,

I understand your issue. Pelvic floor dysfunction is usually associated with problems in bowel movements and constipation is usually one of the symptom though it may not always be present.
It is usual for this disorder to cause urinary or bowel problems and pain especially burning pain is rare. However a hypertrophied ligament pressing a nerve and causing pain can be a cause and can be diagnosed during evaluation of pelvic floor dysfunction. So getting an evaluation by a physical therapist will not harm. Nerve stimulation tests may also be used if needed.

You had mentioned about soreness in the area as mentioned by your doctor, so it indicated more of an infection or irritation. If it is not there then a neurologic origin to the pain is possible. Hence the vitamin B12 and folate help in maintaining the nerve sheaths and so help with such pain.

Using steroid for one or two applications does not help. It takes time to act say atleast 3-4 days. I have already said that you have tried most of the remedies and it has not helped. Applying more and more drugs to that area may agggravate the inflammation or sensitivity of that part. So just use simple vaginal lubricants to cover up the affected area like a film on it. Do not use too many different drugs. I feel that already it may have become a bit sensitive.

Just let it rest and remain lubricated and watch. I understand it is easier said than done considering the agony.

Meanwhile get an evaulation by a physical therapist and also a neurologist if possible so as to rule out the causes.

Take care.
Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 20 hours later
Hi, I was evaluated by a physical therapist today who specializes in female pelvic floor dysfunction. She completed both an external and internal examination of my pelvic floor muscles and said that my muscles are very tight, especially on the left side, adding that my left hip is higher than my right. On the internal exam, which was a bit painful, when she pressed her fingers into the left side, it felt as if she were scratching me with her nails; yet, of course, this wasn't the case. She said that this is the area that is causing the burning sensation I've been experiencing. She said that my signs and symptoms were classic of vulvodynia. I asked her why then do I not have external irritation and inflammation as reported in the list of common symptoms, and she said that not all women will experience this. I was instructed on several stretching exercises to do three times a day, and I have weekly follow-up visits scheduled. She also instructed me to walk for 20-30 mins as often as I am able, and to avoid sitting as much as possible for the time being, and to avoid sitting for chronic prolonged periods at any time. Once she gives me the green light, I will return to pilates. I am still experiencing some pain, but feel that there is a light at the end of the tunnel. I am a natural optimist and so can only envision myself restored to balance. I appreciate all of your time and guidance through my ordeal. You are a beautiful soul~* Thank you,XXXX
doctor
Answered by Dr. Madhuri N Bagde 19 minutes later
Brief Answer:
Thanks!!

Detailed Answer:
Thanks for the appreciation once more. Makes my day.

I am glad that there is a diagnosis at place and hope you will get well soon.

Take care and wish you all good health.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde 14 minutes later
Glad to have been a part of making your day brighter~*

Thank you for your care and well wishes!

Wishes to you for all things that light up your heart and put a smile on your face :)

XXXX
doctor
Answered by Dr. Madhuri N Bagde 17 minutes later
Brief Answer:
Thanks

Detailed Answer:
Thanks!!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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