A Tale of Dry Fanny Woes

 Connective Tissue disease throws new curve ball every so often and sometimes it is hard to discern symptoms that are from the disease or this is something totally unrelated that the body has dreamt up. This blog follows on from my Time to Talk About Menopause.  Post-menopause is a gift that keeps giving and one of them is dryness of the vagina and perineum. It makes for a painful intercourse and also if the dryness extends to the perineum it will burn and pain when urine touches it and when you wipe your self dry. Oh yes you might not notice till the dryness extends outside the vagina if you are not having sex…. For after all your libido is most likely down and you cannot be bothered to have sex. However, with connective tissues which is also another gift that happily keeps updating symptom list you can have drying of mucous membranes like eyes, mouth and of course vagina and perineum.

With is background information I tell my tale of dry fanny woes. I noticed this dryness of the perineum and wondered what happened. With some contortion and a mirror, I could see that the perineum as dry, in fact there was a white patch as it was so dry. I had been applying some tea tree cream as it is anti-inflammatory as well. It seemed to get better after a few days. This went on for a few months and then it would not help so started applying some coconut oil which again was not thick enough to last long and so continued the pain and occasional itching which also comes from drying of surrounding skin as well. Eventually gave in and went to my GP and as I described the dryness and a white patch he goes, ‘thrush.... get something off the pharmacist’ all without looking at my face let alone my fanny! Am like ‘but it is not itching or having any flaking or discharge’ and he says get stuff for thrush.

So now I am at the pharmacy asking to talk to the pharmacist and hoping to get more sense. She asks me more questions than my GP and says maybe you need something thicker than oil and why not try Sudocream and you can apply if a few times (well I could apply the oil too many times but…) So, I pay for a small tube to try out and see if it helps. So off I went and religiously applying this white paste and happy as of course now the urine does not touch the naked perineum. Oh, ladies have you ever experienced the contortions we can do when weeing to avoid the dribble of urine on to the perineum. Bending forward and raising your butt at the end is a useful way if anyone was wondering. This helped for a couple of weeks and then we were back to square one.

Return trip to the pharmacy and this time a different lady who again went through the umpteen questions by now I was getting adept at describing the symptoms. She comes up with - if it hurts have you tried something with a bit of anaesthetic? Then she picks up a tube of haemorrhoids cream. I am like, ‘are you sure one can use this for my symptoms?’ She says of course you can use it we do tell people it is safe to use. Now I was pretty desperate so I nodded and went of with yet another useless cream. A word of warning to people who are not up with their pharmaceutical knowledge the haemorrhoids cream is to reduce the size veins which are bulging and thus reduce blood flow and the anaesthetic acts on the nerve endings to reduce pain. Now these would have little effect on the dry mucous membranes whether due to lack of oestrogen or connective tissue disease. If ever any one gives you this for your fanny kindly refrain from taking it. All it caused was even worse burning on application.

By now I was dreading passing urine and upending myself to avoid the trickle of urine that I was not quick enough to catch on the tissue. Time to go to the GP again and this time go to the wife of my GP who also works there. I say to her, I need you to actually physically look as I cannot diagnose what I cannot see properly. I said her husband had just said thrush with his head down. And so did my rheumatologist for that matter. Now this usual po-faced lady is giggling. I am like sure she is going to take the piss off her husband when she gets home. She asks about why I have had no smear test and I said cannot be bothered. (But that’s another story where they are not competent and appear to dig for oil than take a smear… and I am not bothered to find someone else.)

Then comes the well know lie on the couch and spread them. She gets a speculum out and I tense as she does not have a gentle touch. Says to me all the mucous membranes are red and dry. Her diagnosis is post-menopausal dryness and treatment is oestradiol cream twice a week for 3 weeks and then review. She does not like giving HRT so I am not to expect to continue this beyond the time it clears the dryness. Funny she never asked me about how did I not realise this extreme internal dryness as intercourse would be excruciating. She is a lady doctor who I have seen providing perinatal care and the serious lack of examining the sexual health and indeed the giggling was strange. She totally discarded my suggestion that it could also be due to my autoimmune disease. Well I was happy I got some medication and that would resolve my symptom.

So, oestradiol cream was duly applied twice a week. If you have never had to apply this maybe I should explain. There is a syringe which you screw on to the opening of the cream tube. Then you squeeze the tube to fill the syringe which is a fixed amount. Then you lie back and insert the syringe into the vagina and empty it. Hope you have a helper handy to take the syringe, wash it and put away as you need to lie flat for a while. The dryness seemed to get less along with less pain and burning. During this time, I had a migraine and had ibuprofen for a couple of days. Suddenly the last remnants of the symptoms vanished. Therefore, I think it was a combination of lack of oestrogen and local inflammation that caused my symptoms.

Went back for the review and po-face was back when I said I have ibuprofen and the last of the dryness went. Instead of showing concern and acknowledging there could be a dual reason she just clamed up and lectured me about how dangerous ibuprofen was and that I should take paracetamol before I try ibuprofen (all not necessary as I have been having ibuprofen for over a decade and am well versed with its effects and side effects). Ah she does not like being proved even partly wrong this one! So, after care was less amusing to her. I could have the cream for another week or so and then I should keep KY Jelly handy.

How very helpful and caring this whole experience has been … NOT. My problem though hard for me was actually not that serious and that as a nurse I had such a poor experience what happens to others?  I think we ladies should stop being shy and demand that we get support, care and treatment as required for our whole body and not just with bits that people are comfortable with. This lack of care from health staff leads to women being ashamed to talk about real and very traumatic reproductive organs diseases.