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Hi there,
I’ve been dealing with BV for two years, along with awful burning, itching and rawness on the labia minora, majora and vaginal opening – and sometimes the itching spreads towards the anus. I keep my BV under control with boric acid and probiotic inserts (not using them right now, just taking probiotics orally).
I read your Killing BV guide and followed it for a while, then switched to directly inserting capsules (Klaire Labs Ther-Biotic Women’s Formula). After Christmas the burning came back with a rage, so I did two weeks of boric acid and probiotic inserts and saw my doctor. She tested me – no BV or anything – except a very red, sore vaginal opening with two red streaks on the inside of the labia minora, which are often there during a BV flare.
I have at least eight documented lab tests positive for Gardnerella. My doctor suggested contact dermatitis and put me on clobetasol ointment [a topical corticosteroid]. After three weeks there wasn’t much improvement, and when I said I feel very damp there, she suggested Aquaphor [a petroleum-based skin protector] during the day too.
We discussed a biopsy, but she felt that even if it were lichen planus or similar, the protocol would be the same. I also use bio-identical hormones compounded by a pharmacy (could these be a culprit?). I’ve read about hydrochlorothiazide [a diuretic for high blood pressure] contributing to vulval problems – do you know of this?
I take it for my BP and would need to switch to something else if I stopped. This all started after my hysterectomy, around the same time I started the hydrochlorothiazide. If it’s the culprit, would stopping fix it? Suggestions? P.S. I’ve had Mona Lisa laser treatments and think they’ve been a success, even though I still have this rash.
Yours,
Unresolved
USA, age 57
Hi there Unresolved,
You’ve clearly done your homework, and there’s a lot woven together here, so let’s take it point by point. In our clinic, the trickiest recurrent-BV cases usually turn out to have a second thing going on underneath, and I think yours does too.
Is it actually BV?
Probably not on its own. Your repeated Gardnerella positives tell us BV has been part of the story, and the biofilm is what makes it stubborn. But burning, itching and rawness that spread towards the anus, on a swab that comes back clear during a flare, don’t behave like BV. That mismatch is the clue that something else is driving your symptoms – and treating BV harder won’t fix a non-BV problem.
The part I’d chase first: a vulval skin condition
A postmenopausal woman with two years of vulval burning, itching, rawness and red, sore skin that isn’t settling is a classic picture for a lichenoid skin condition – most often lichen sclerosus, sometimes lichen planus. I’d put this near the top of the list.
This is where I’d gently push back on the plan so far. Clobetasol not clearing it in three weeks does not rule lichen sclerosus out – in fact clobetasol is exactly the right treatment for it, but it usually needs a longer, structured course and then ongoing maintenance, not a short trial. Three weeks is simply too soon to declare it a failure.
So I’d actually encourage the biopsy your doctor raised, rather than shelving it. The reasoning that ‘the treatment is the same anyway’ isn’t quite right: knowing whether it’s lichen sclerosus, lichen planus or plain dermatitis changes how long you treat, how you maintain it, and how you’re monitored over time – and untreated lichen sclerosus does need proper long-term follow-up. A confirmed diagnosis is worth having.
The red streaks
These could be a feature of that same underlying condition, or fragile, inflamed skin splitting a little. I wouldn’t pin them on the laser, though it’s not impossible. This is exactly the kind of thing a specialist looking directly at the skin can interpret far better than I can from a letter.
Steroids and Aquaphor
Steroids are wonderful for calming things short-term, but used on and on they thin and weaken the skin, so they’re a tool with a use-by date rather than a long-term answer. Aquaphor as a daytime barrier is reasonable for protecting sore, damp skin, though it won’t treat an underlying condition – it just protects the skin while something else does the healing.
The dampness
Constant dampness can come from a few places worth teasing apart, including a benign cervical ectropion or the hormonal changes after your hysterectomy. It’s worth mentioning to whoever reviews the skin, because damp, macerated skin makes any vulval condition feel worse.
Your blood pressure medication
It’s fair to wonder about the hydrochlorothiazide. It’s a diuretic, so it pulls water out through the kidneys, and less overall fluid can mean drier tissues – which for some women shows up as vulvovaginal dryness and irritation. The research isn’t clear-cut, but that doesn’t mean it isn’t happening for you.
Since the timing lines up with when this all began, it’s a very reasonable thing to raise with your doctor. Ask whether you could trial a different class of BP medicine that works in another way, so you can see how much of a difference it makes. You’d swap one set of possible effects for another, but at least you’d know.
Bio-identical hormones after a hysterectomy
Yes, these could well be part of it, especially combined with everything else. It’s worth having someone review your doses and how they interact. Being postmenopausal, your vulva and vagina also do better with a little local oestrogen support – something like oestriol (E3) cream or a Fennelope pessary can help the tissue and the lactobacilli, and may be gentler on the microbiome than a broad hormone mix.
A quick safety note on boric acid
Boric acid is fine used vaginally as a pessary, but it must never be swallowed – it’s toxic taken by mouth. From your letter it sounds like it’s the probiotic you take orally and the boric acid you use vaginally, which is exactly right, but I mention it because people occasionally mix the two up.
Where I’d point you next
Two things would move this forward most. First, go back to your doctor and press gently for that biopsy and a proper look at whether this is lichen sclerosus or planus – that’s the missing piece. Second, for the blood pressure and the whole-body picture, a qualified naturopath or herbalist can work alongside your doctor on diet, herbs and lifestyle, and on settling your vaginal environment while everything else is sorted.
You’ve been at this a long time and you’re clearly a sharp historian of your own body, which will make a specialist’s job much easier. Do write and tell us what the biopsy shows – I’d love to know.
Warm regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice.
