Recurrent Perineal Cuts - Negative HSV

[QandA123]

Hello and thanks in advance for any advice. About 6 months ago I had an HSV scare. I developed an initially painless UTI that progressed to a constant burning sensation in my urethra after the UTI went untreated for about a week. I was with a new partner, protected (without oral sex) in early February. A week and a half later, I developed a UTI; there was no pain (just frequent urination), and no cuts or lesions. I visited with a primary care doctor as well as a gynecologist and urologist. All examined me inside and out, and saw nothing abnormal. Fast forward to about a week after the frequent urination began, and my urethra felt like it was on fire 24 hours a day for months. I suspected interstitial cystitis and sought out the help of a urologist. He was unable to find anything physically wrong, even after a cystoscopy which ruled out any kidney stones, internal ulcers, inflammation, etc. During this time, my only issue was the burning urethra, and I went back to my PCP and gynecologist time and again for them to do internal and external checks to see if anything looked off. I was told by both that there were no visible issues, and even told by the gynecologist that everything looked exceptional: the cervix, the perennial skin, clitoris and labia. I even shared my fear that it could be an undiagnosed HSV infection and she thought it was incredibly unlikely, with no physical evidence pointing to it. Pair that with my negative tests, and she recommended my next step be physical therapy.

Now, fast forward 6 months from when this all began, and I am experiencing a couple of recurrent fissures in my perineal area. Of course googling online, everything points to herpes, but I was tested 2 weeks, 10 weeks, 16 weeks, and 6 months after my last sexual contact with Elisa IgG tests -- all negative for both HSV1 and HSV2. My fissures tend to appear no more than 1-2 at a time, and while mostly on the left hand side of the perineum, I have spotted a couple on the right hand side simultaneously. The cuts are very small, don't really hurt even if urine gets on them, and I treat them by applying a steroid cream which usually makes them shrink or disappear in a single day. The problem though is that they keep coming back.

Since the start of all of this, I have been on various antibiotics, never on any antivirals, have tested negative for yeast and fungus, negative for HSV, had a clear pap smear negative for any high risk HPV, and did a full panel of STD tests with everything coming out clear. I got into the (bad) habit of checking out my genitals on a daily basis, and suspected that constantly stretching the skin was, if not causing, exacerbating my problem. However, I also stopped taking birth control about 2 months into this saga, and had not noticed any cuts or fissures prior to stopping the birth control, so I do wonder if something hormonal is going on here. However, I have PCOS, and have not had regular periods without taking birth control for years, but since I stopped 4 months ago, I have been having a completely, predictable, timely period, which then makes me question a hormonal issue.

This has really taken a physical and mental toll on me, and while I've ruled out my biggest fears in stages: first a chronic UIT, then interstitial cystitis, then herpes, and I've treated suspected vulvodynia with tricyclic antidepressants and this calmed the burning sensation down greatly, but I'm still at a loss. Are recurrent perineal fissures a common thing? I do recall *feeling* perineal tears every so often, with them being uncomfortable enough to apply neosporin, but it never occurred to me to LOOK at my vulva until now, so I have no idea if what I'm seeing is what has always been present, or if there's something new going on with my body.

Even though the steroid cream helps, the fissures just keep coming back! Any ideas what is causing this and how to get them to go away for good?

Thanks again if you made it all the way to the end.