Severe perianal, anal, vulval itch and burning sensation

I have been suffering from vulval, perianal and anal itching (mostly in the inches surrounding the opening, but not anus itself) for almost two months now.  I have seen two doctors, the first prescribed flagyl for bacterial vaginosis.  During the course of this treatment i did not receive any relief from the severe itching.  The second doctor thought it might be a small yeast infection on the skin's surface and prescribed two different creams (the second two weeks after the first treatment failed): nystatin and canestin.  I last used treatment over 3 weeks ago.  I have been examined and tested, and std's have been ruled out.  My family doctor said the skin did not appear inflamed but that i had a slightly yellow discharge.  When I inspect the area, it appears to have a small rash -  very small bumps are visible that were not present before, and covering most of the skin and mucous membrane from my urethra and back.

Since 3 weeks after this exam I have not noticed any abnormal discharge, and for about a week the itching became less noticeable.  Now however it has returned and tends (like before) to be quite severe late in the day, after exercise, and when i am trying to fall asleep. There are no symptoms immediately when I wake up before using the washroom.  The itching is eased by warm or hot baths with vinegar, but not baking soda or salts.  It is aggravated by toilet paper.

Since the onset, I have changed to fragrance free soap, bathed without scrubbing, changed toilet paper and wear only cotton underwear.  For the last week I have applied an otc cortisone cream to the crease of my buttocks, but not the anus- this helps briefly for about 1 hour or less.

Please help, I am very concerned and irritated.  Should I continue to seek help from a doctor, or is this something that should go away on it's own?

[Vanessa Lacuesta]

Hi.

This sounds like there is an overlying bacterial infection. Have you sought consult with a gynecologist? I suggest that you see your gynecologist for this so that a pap smear and culture of the discharge may be done to help guide treatment. A urinalysis may also help rule out a UTI .A fungal infection may also be present and this may help explain the persistence of the condition.

You may need oral antibiotics for this.

[KAM_1958]

Have you ever heard of lichen sclerosus?

http://www.niams.nih.gov/Health_Info/Lichen_Sclerosus/lichen_sclerosus_ff.asp

http://www.mayoclinic.com/health/lichen-sclerosus/DS00725

http://www.medicinenet.com/lichen_sclerosus/article.htm