sensitive skin--advise

[thisperson]

I am 22, female who has asthma as well as allergies(eczema also runs in my family). For the past 2+ months I
have suffered from really sensitive skin in the vulva area, at times very stingy,red and just irritated in general. There
are no lesions,odd discharges, odors, etc. I went for my annual check up and brought this concern up with my OB/GYN.
All pap tests were clear and they did a routine STD check, including yeast cultures as well (which were all negative). The doc
said he didnt see anything out of the ordinary and advised me to use cortisone as an anti inflammitory as needed to calm the skin.

Things seemed to alleviate but have flared back up again. I notice when I exercise (run, ride bikes) it gets worse, but I
cannot keep my life on hold...geez. I dont use any scented bath products, am very sanitary (perhaps too much, to the detriment
of delicate skin?) It does not interfere with my sex life (which is monogamous and STD free), but it can become quite a nuisance
and stings from irritation at times :(  Here are my questions:

1.Is yeast possibly the problem even though a culture was taken and nothing was found (I didnt pre-treat with anything before
the test that would alter results) I ask because I heard this is sometime missed during a diagnosis.
2.I have never had any suspicion for herpes and no blood test was done because of this fact, but with all this talk of atypical herpes,
is that even a remote possibility? I have a modest sexual history and never engaged in unprotected sex with anyone I did not know for sure
was tested and STD free--but knowing docs dont generally test for herpes without an outbreak, someone could carry it and not even know, right (thus possibly
passing it on to their partner?) A longshot, but may as well ask...
3.Would this irritation just spring up from nowhere, given my history of asthma and sensitive skin? And would it be common to last for so long
(altogether off and on in varying degrees over 3 months or less)? Given the area of irritation, I suppose healing time would be more prolonged?
4. What can I do for this? I am living overseas at the moment and cannot get hydrocortisone without prescription (even the 1% kind). I was given
something by a pharmacist who my partner described my needs to. Its basically, from what I gather a non steroid anti-inflammatory cream. Effective to use in this case?
5.I feel like I have done everything suggested within possible reason to help settle it down, any further ideas or recommendations? I am in Europe, just in case that helps with medicine names, etc.

Thanks so much.

[H. Hunter Handsfield, M.D.]

I probably cannot help much, although perhaps you will be reassured by this:  You can be very sure that no STD is causing the symptoms you describe.  But your own provider's assessment after personal examination, plus the test results, is far more reliable than judgment I can make by verbal description.  If you have not done so, ask your ObG about idiopathic vulvodynia.  As the name itself indicates (idiopathic = cause unknown, vulvodynia = vulvar pain), the reasons are not known.

1) If a culture was done and yeast wasn't found, you can be confident you don't have it.  The problem with culture is that it often shows yeast that means nothing, but a negative test is reliable.  You could try one of the over-the-counter yeast preparations, but I don't expect it to help.

2) Recurrent irritative symptoms always raise the possibility of herpes, but it sounds like your symptoms are too frequent.  Herpes symptoms occur in discrete outbreaks that typically last 5-10 days and recur no more often than once a month, with no symptoms at all between those episodes. But if in doubt, your provider can order a blood test to check it out.  If positive, it won't nail down the diagnosis, since so many people have positive tests without symptoms.  But if positive, a trial of antiherpetic therapy might be worth a try.  But don't get your hopes (or fears) up; I doubt herpes explains it.

3)  I cannot comment on potential relationship to allergy or exercise. Your ObG would be a better source of this info.  Vulvodynia symptoms may vary with these things, but I don't know.

4,5) As implied above, I have no specific recommendations.  Clearly no STD explains your symptoms, and that's the limit of my expertise; I'm not a gynecologist and have little personal experience managing such problems.  You'll need to follow up with your ObG, or seek a second opinion if uncertain about his/her expertise.

You might also look to other responsible websites for information about vulvodynia.  Be careful; as for many otherwise unexplained health problems, the greatest internet "noise" comes from affected persons with pet theories about the causes and treatments.  You'll probably have to search through a lot of **** to find useful information.  Look for sites run by responsible, non-advocacy organizations; and for sites with comments by the public, look for those that are monitored, like this one is.

Sorry I can't be more helpful.  Good luck--   HHH, MD

[thisperson]

Hi Doc, reading over to make sure I let you know everything. The irritation is never internal, as is common with yeast infections. Is some sort of fungus still a possibility?

Thanks

[thisperson]

Thanks a lot. Do you think it would be possible to forward this question to the dermatology forum, so the doctor there might have a look at it?

If not, I understand--I guess I should have posted it there to begin with. I really appreciate your reassurance, though.

[who_is_this]

You say "I am very sanitary- perhaps to my detriment".

Are you overwashing the area?  Perhaps that is the problem.  The normal, healthy vulva requires little except for a daily cleaning with a very mild soap.  That's it.  No douching, no baby wipes or personal cleansing cloths, no sprays or anything else.

Use soft cotton panties and try to change soon after exercise or sweating if you are getting irritation after exercise. If you feel you must do something after exercise in the way of cleansing, just rinse with plain water and pat dry.   Do not wear pantiliners or pads.  Once a day cleansing in the shower should be all you need to do.  

[H. Hunter Handsfield, M.D.]

I have no way of transferring your question to another forum, and I believe you have to re-post it there yourself.  But you can use the "Contact us" link to ask the MedHelp admininstrators.

HHH, MD