I am tearing up.

June 17, 2011 10:44 AM

My skin keeps...tearing. What could cause this?

I am female, twenty-mumble, in general good health. I will preface this with that multiple (3-4) STD tests over the span of 1.5-2 years have all come out clean, although I don't actually remember the scope of said tests.

Over many months, I've noticed the area of my skin that's between my anus and vulva/vaginal opening (the perinium?) to be particularly...thin. As in, something I'll be walking, take a stride, and I can feel the skin tear. Or sometimes I can be rolling over in bed (rolling my hips sideways, as I was sitting up on the bed and moving to get off the bed) and I can feel it tear. Among other activities, most as mundane as those.

I thought it might be the birth control I'm taking (Yasmin, which works quite well with me) thinning out my skin, since I've noticed this a lot more in the 1.5 odd years since I began taking it. But my doctor said in puzzlement that in the 20 years she's been in practice (and prescribing birth control) this has not come up as a side effect. She said she's heard of herpes as a cause, but, well, clean bill of health from STDs. I'm trying to figure out what else might cause this.

My sex life is pretty vanilla; I have what I think is a minor case of vulvodynia, so penetrative sex are not marathons and end probably in about 5 (I think that's below average. Foreplay and oral and all that, though, go for hours). A vibrator is used externally, no pokey bits, and I don't have penetrative toys. I am monogamous, and my boyfriend also got an STD screen before we had sex, and he was clean. (He is my first sexual partner, I am his fourth.) When I go to the bathroom sometimes I wipe in a very long stroke from vulva to anus which quite frequently irritates the area (yes, I probably shouldn't), and it's likely that it could abrade the sensitive area too, but it doesn't explain why I could be shifting my body with my pants up and I still feel it tearing. To be fair, though, even though right now it's in the midst of an episode where I have these tears/abrasions, I can't remember when it actually occurred, so maybe the tears aren't happening that frequently and the abrasive wiping is just aggravating it. Or something. Tearing while moving definitely has occurred though, I just don't remember frequency.

Boyfriend's inspection (it's not in an area I can see, even with a mirror and I crane my neck) said that sometimes there's up to about 5-7 red lines. They look/feel superficial; kinda like a papercut; stings a lot but feels shallow and (I think, since I can't see it) heal pretty quick.

So, not STDs, reasonably clean bill of health. What is causing this? Any suggestions, MeFi?

posted by anonymous to Health & Fitness (25 answers total)

Sounds like chafing underwear to me.
posted by Electrius at 10:50 AM on June 17, 2011

Are you dehydrated? If you pinch a bunch of skin on your forearm, does it "stay pinched" (tenting) for a second or two or does it immediately return to normal? If it stays pinched that can indicate dehydration.

Suggest you modify the wiping technique for a bit to dab at vulva/vagina, then separately the anus, without dragging over the area between them. Dragging toilet paper repeatedly over sensitive skin can cause irritation and skin breaks.
posted by de void at 10:56 AM on June 17, 2011

This could be something related to the vulvodynia, per what is described in the V book.
posted by tanuki.gao at 10:56 AM on June 17, 2011

Skin breakdown can be caused by a number of factors, one of which is maceration (keeping an area of skin moist can make it more likely to tear). What kind of underwear do you wear? Cotton will allow the area to breathe more easily, while silky/polyester blends may be more likely to keep it sweaty without allowing it to air out.

Irritation can certainly come from rough TP abrading the area. Can you switch to moist towelette toilet wipes for a while to see if that makes a difference?
posted by scarykarrey at 10:56 AM on June 17, 2011

Check out Lichen Sclerosus and see if it fits your symptoms.
posted by KathrynT at 10:58 AM on June 17, 2011 [1 favorite]

I've had a similar thing, the red line stingy sort of skin damage, and for me it's caused by irritation. Maybe you can find a vulva-friendly lotion or balm that will soothe and hydrate.
posted by Specklet at 11:01 AM on June 17, 2011

Oh! The other thing that caused that for me was a low-grade yeast infection.
posted by Specklet at 11:13 AM on June 17, 2011 [4 favorites]

Some of the more extreme (as in, if-this-sounds-like-you-see-a-doctor-immediately) types of Ehlers-Danlos Syndrome have fragile skin as a symptom.
posted by Sys Rq at 11:17 AM on June 17, 2011

What kind of underwear do you wear? If you wear thongs a lot, could they be rubbing up against that area? And nthing making sure you're wearing cotton underwear. Do you let the area uh, air out after showers or do you go straight into clothes? And when you're wiping, is the area also getting wet and not getting quite dry? Moistness + abrasion could be making the skin prone to tears.
posted by MadamM at 11:22 AM on June 17, 2011

Underwear could be a big issue. A cotton crotch is what's usually recommended, and what most underwear has, but I don't think that's really the best thing--everyone knows cotton tends to stay soggy once it gets damp. I would try using only silk (I know, life is tough), or maybe the "technical" wicking fabrics that athletes use. Actually, the wicking synthetics might be too drying, so definitely silk, only silk. Skin and silk get along very well together. Really--when you sweat in silk, it dries right away and never, ever gets smelly. Wash it gently with just a bit a vinegar instead of detergent, to avoid allergy issues.
posted by Corvid at 11:24 AM on June 17, 2011

You should mention this as your next OBGYN appt, and schedule one in the next few weeks possible, but I wouldn't freak out about this. I has something that sounded identical and it resolved itself with a few basic changes. (A fistula, FYI involves a tear in muscle and other layers of skin - it doesn't fit with what you've described.)

I has the exact same situation, same area of skin, same symptoms -- I wouldn't even notice any tear, but then there'd a few drops of blood from a small tear. The GYN kept doing (negative) test for herpes and other STDs, but there were never any results there. They concluded it was just basically really dry skin. (liked chapped lips, basically. yay.) The skin was just sorta failing at being skin.

It went away, and the things I think helped were doing as much to protect the moisture in the skin. Don't use any soap on that area at all, and only use something very gentle nearby, like cetaphil. I also saw improvement when I added daily omega-3 capsules, and tried to eat more healthy fats.

All the other info about keeping the area sweat-free and dry probably help, too. This resolved for me in about 2-4 weeks (after switching soap and adding omega).

Good luck, memail me if you want to vent, and good luck.

(I created this shiny new sockpupet just for this -- it was superstressful when it happened to me, but it went away and hasn't resurfaced in years)
posted by IANYsock at 11:45 AM on June 17, 2011

Are you shaving/waxing/depilating in some way in the general area? That can cause all kinds of wacky irritation.
posted by elizardbits at 11:58 AM on June 17, 2011 [1 favorite]

This sounds really serious! And scary. So, first of all: any relation to your cycle and the tearing incidences? The birth control could be masking some issues, or making them worse, if it isn't directly correlated.

Have you been tested, not just for STDs, but bacterial or viral infections? Any history of yeast infections? Basic guidelines would be to wear breathable cotton underclothes and not tight elastic or nylon, dab rather than wipe (of course front to back), separate wipes for the anal area to avoid bacterial infections, and keeping really hydrated to avoid UTIs.

Could you be having an allergic reaction? It might be a form of contact dermatitis. Are you wearing different lingerie or underclothes or maybe using a different detergent? Even something simple, like dye in, of all things, toilet paper, can cause problems if you are already sensitive. Try dye-free, hypoallergenic detergent and TP (seventh generation makes some and you can buy it through Amazon).

Dehydration, corticosteroids and nutritional deficiencies are also correlated with skin tearing in general. How's your diet? Do you drink enough? Taking any medications other than birth control?

Anyway, now you have some possible causes you can explore. I feel for you, and hope you get this figured out. Sounds pretty miserable.
posted by misha at 11:58 AM on June 17, 2011

sounds like a yeast infection. have you been tested for that?
posted by hollisimo at 1:43 PM on June 17, 2011 [1 favorite]

Another possibility I haven't seen mentioned yet is thinning from frequent use of hydrocortisone.
posted by moira at 2:45 PM on June 17, 2011 [2 favorites]

It could be a reaction to your soap. Even soap that you've been using happily for years can suddenly start having adverse effects to your delicate bits. Either try not using soap at all in that area, or if that squicks you out, use something that doesn't have detergents in it. They strip away your body's natural moisture and dry you out fiercely.
posted by Addlepated at 3:28 PM on June 17, 2011 [1 favorite]

You need to see a gynecologist who specializes in things like lichen, psoriasis in the genital area (uncommon and highly unlikely if you don't have it elsewhere), and vulvodynia. Even then, most likely you'll never know what this is for sure. The specialists can rule many things out (like herpes), but it's mostly diagnosis by exclusion. For many skin diseases like this, noncommunicable diseases, there is no definitive test.

Very low dose steroid cream is a likely treatment, but as people have pointed out, if used continuously or at high doses, it can thin the skin, and that alone can cause more tearing. However, used judiciously, it can help treat something like this (depending on what you may or may not have). Ask a specialist, preferably a gynecologist who also specializes in dermatology. They're out there.

First: yeast can infect your skin outside the vagina, and cause redness and cracks in the skin. Not everyone (not even all doctors) know this. It's unlikely that's the problem unless you're immune-compromised. Try treating with something like monistat for a week. A doctor might suggest a mix of antifungal, antibacterial, and steroid creams for a short course. (It could also be something like staph, which many people carry in their noses, and genital areas, something that infected a break in your skin, and now won't heal). Trust me, Joe-Gynecologist will have no clue what's going on. Look for a specialist, and in fact, a dermatologist that's not shy about the genital area will probably be better than any gynecologist you can find. Some dermatologists don't like to look at the genital/anal area, sadly, so again, look for a specialist. Google can help you start looking.

I notice you're monogamous. Good. I can't tell you how disastrous genital herpes would be for someone with problems there already. It could make your life a hell. I know a few people who have it and don't disclose, or think it's no big deal. Just be careful if you ever move on.

Lastly, what kind of STD test did you have? Swabs for herpes aren't necessarily definitive. Ask for an ELISA blood test. Your boyfriend might want one as well. Educate yourself. Doctors work off as much guesswork as knowledge half the time and won't tell you when they are, so be your own advocate, and ask questions and read.

For the basics: stay hydrated, and stick with cotton underwear. Shower every day, and use very mild, hypoallergenic soap. Try changing your laundry detergent, and going without fabric softener for a few weeks. Use cloth pads for a while, or buy the expensive organic ones at a froofy natural foods store. You want to rule out chemical irritation or allergy, since that's one of the simplest things to check.

Good luck.
posted by thelastcamel at 4:44 PM on June 17, 2011

I had a similar issue that came and went for years; I tried a lot of the suggestions above, like wearing cotton underwear, making sure I was dry, et cetera. The thing that finally did the trick was switching to a scent-free, mild, hypoallergenic laundry detergent.
posted by cortisol at 7:14 PM on June 17, 2011

I have this, and it was diagnosed as lichen sclerosus. The treatment is generally topical steroid cream, which helps a lot. Go see your ob/gyn.
posted by media_itoku at 7:36 PM on June 17, 2011

I have this basically, and it flares up when I have a yeast infection. My doctor took a look and said it looks like I have unusually wrinkled skin there, and it's likely that moisture gathers in the wrinkles and makes a pleasant home for yeast. Cotton underwear and pants help. She recommended using the topical antifungal cream that comes with Monistat, which helped.
posted by troublesome at 8:00 PM on June 17, 2011

I had this and it would itch like crazy! I checked with the dermatologist that I was working for at the time and she said it could be lichen sclerosis. I just used the Vagisil chafing cream and it went away. it will still itch from time to time, but that is more of an anxiety issue and not related, I don't think.
posted by summermoon at 11:49 PM on June 17, 2011

Mod note: From the OP:

Thanks for the tips--I'm responding point-by-point, but skip to the questions below if it's tl;dr:

I'm reasonably hydrated; drink fairly regularly throughout the day.  Drink alcohol maybe 2x a year.  Drug-wise, Yasmin is the only thing I regularly take; rarely take vitamins.  I don't know if these have any correlation to what point I am in my cycle; never kept track.  (I'll start!)

On the underwear front: I own nothing BUT cotton underwear, no thongs.  They're all bikini cut cotton, although some are smaller than others.  I may throw out the smaller ones given the indication that chafing underwear can cause this.  I use a menstrual cup for my period, which probably helps.

STD tests have included the usual chlamydiae/gonorrhea for sure, HIV, not sure others (I've had swab tests, blood tests and urine tests, and the only thing I remember about them is that they told me I was clean for everything they tested but I can't remember for what).  I shave down there occasionally with an electric razor (leaves a bit of stub, but won't itch like crazy the next day), but so seldomly that I'm more likely to be unshaven than shaven, so I don't think hair is a factor.  No cortisteriod use, no hydrocortisone cream use.  My diet can use more vegetables for sure, I'm reasonably good on fruit, dairy, meats, grains and fibre.  I do not eat fast food.

I sweat easily, and also I tend to have a lot of...discharge...naturally.  I've always had it.  My pap smears have all come out clean with the occasional super-minor-yeast infection, so the conclusion is that I'm just naturally...damp in the discharge department.  The discussion about damp + chafing is a very likely possibility.  I don't think it's yeast given this is a constant low-grade problem through even completely clean paps that don't report yeast infections (which is most of them), unless it's possible to have a yeast infection in that area only without affecting the rest.  Is it?

Questions:

1) Change my soaping habits.  I usually just use whatever soap/body wash I'm using, often they dry out my body-skin...never thought about it drying it out there.  Can I wash all my bits with Cetaphil or just water only?  Due to discharge/sweat issues, I always feel kinda ick if I don't wash with soap...

2) Should I add moisturizer?  I put Vaseline or antibiotic ointment when it's stinging to make it feel better, but that's all the care I do.  It sounds like damp + friction might be a culprit due to sweat/discharge, but it also sounds like my drying soap might also be an issue.  Is there a middle ground?  (Any recommendations for moisturizers?)

I'll take all the advice into account and immediately fix my wiping habits and look for a better laundry detergent.  And probably another doctor's visit.  Thanks for all the suggestions and please give more if you can!

posted by mathowie (staff) at 4:25 AM on June 18, 2011

You also might make sure you are using plain unscented toilet paper, nothing scented.
posted by tamitang at 9:04 AM on June 18, 2011

A doctor recommended Balneol for cleansing when a friend of mine developed pruritus from cleansing with soap, the same stuff she'd been using for a dozen years. My friend did not end up using the Balneol, but after several weeks of using water rather than soap, the problem is gone.

Maybe you could reach some sort of happy medium, finding a hypoallergenic, non-detergent cleanser to use, and until you are healed only use it every two showers, then work up to every other shower, and so on. Also, have you thought about asking a dermatologist about this?
posted by Addlepated at 10:48 AM on June 18, 2011

I put Vaseline or antibiotic ointment when it's stinging to make it feel better

I would recommend skipping the antibiotic ointment, at least until you run it by your gynecologist. There's a rather delicate balance of microorganisms naturally living in that area, and killing off the good bacteria with antibiotic ointment can lead to an overgrowth of other, less-desirable organisms, particularly yeast.
posted by vytae at 3:23 PM on June 19, 2011