6:46 pm - 04/30/2006

Perineum problems (TMI warning)

For the last couple of years I've had a recurrent problem with the skin of my perineum. On a regular basis, maybe every other week, when doing #2, my skin down there splits - only the uppermost layer of the skin, just enough to show a fine red line when I check with a mirror, and very, very rarely a tiny amount of bleeding. It mostly happens when I have hardish stools or when I have diarrhea but sometimes also when there is no reason at all.
These skin splits heal very quickly and I haven't been able to show them to a doctor. There is no yeast present, and no other infection. Just the "ouch" moment, and then it really burns like hell for a few days when peeing...

Now, I know that I should avoid constipation and diarrhea, but I live in a country where things can be a bit hit or miss in terms of cleanliness, and I tend to not be the "daily" person. Of course I try not to irritate things with rough toilet paper or harsh soap. But other than that I really have no clue what to do.

Background info: 38, not on hormonal bc, no births (or pregnancies), no hemorrhoids, no other skin issues.

Any ideas as to what this might be? Had it and fixed it?
amigone 1st-May-2006 12:13 am (UTC)
If it's with hard stools, try a stool softener. Something with docusate sodium.

It is very gentle, and will soften the stool wihtout irritating your colon and giving you the runs. It is available over the counter

Good luck :)
mangosorbet007 1st-May-2006 12:17 am (UTC)
Thing is, I don't usually have hard stools, and this also happens with the opposite. I also eat loads of fiber and drinks buckets.
amigone 1st-May-2006 12:28 am (UTC)
Hmmm. I am honestly outof guesses...
mangosorbet007 1st-May-2006 12:40 am (UTC)
Me too. :-(
joybeans 1st-May-2006 12:28 am (UTC)
I have that SAME problem when having sex! I've often wanted to post here about it, but just never got around to it.

I generally just put a little A&D ointment, vaseline or neosporin on it to help it heal. It's annoying. :\
mangosorbet007 1st-May-2006 12:39 am (UTC)
Now, see, *that* I used to have too. I blamed it on the fact that I do not get very wet and on my guy at the time who was rather "well endowed". But then I went off bsp and it went away completely.
joybeans 1st-May-2006 01:03 am (UTC)
The tearing happens sometimes with #2 for me aswell. There doesn't seem to be any real rhyme or reason for it tearing during sex. It doen't happen ALL the time, but does happen under different circumstances. I think it's just part of my angry vagina, she's branching out with her agression. heh
aechei 1st-May-2006 12:42 am (UTC)
i would not recommend anything petroleum based down there. however, hydrocortisone cream is okay to use on genitals and external anal issues, and it really helps any sort of irritated or overdried skin. also stops itching like no ones business.
lovelustkill 1st-May-2006 12:48 am (UTC)
it sounds like an anal fissure.
if it keeps reopening, chances are it's not healing properly. anal fissures, once closed, shouldn't re-open. there are several things you can do: increase your water and fiber intake to avoid constipation. when you need to have a bowel movement, do not restrain from doing so. this can lead to constipation.
after you have a bowel movement, make sure to gently clean the area (regular toilet paper can make the problem worse) so try a non-perfumed baby or soft cloth wipe. try having a sitz bath (soaking the area in warm water) several times a day. this increases blood flow to the area and promotes healing.

however, you do want to have this checked out by a doctor. recurring anal fissures can be a symptom of an underlying condition such as some STDs like herpes that can affect the anus but have no vulva symptoms, colon cancer and inflammatory bowel disease. he or she might also prescribe you a cream that will speed the healing process. sometimes surgery is required to correct chronic anal fissures, but most resolve without this.
mangosorbet007 1st-May-2006 12:58 am (UTC)
I had an anal fissure some 10 or so years ago, after being on industrial-strength painkillers for a while, and while this is somewhat similar, I doubt it is the same. The tear/split doesn't even actually reach the anus at all (and believe me, me and the significant other have checked more than once, and -- TMI -- my anus enjoys the occasional vigorous activity without any comparable problems ;-).
My main issue is not the healing as the tears heal just fine. It's more the "Why does this keep happening?" My skin apparently allows for all sorts of activities down there but breaks when doing what it is supposed to do? Weird...
(And just to make this clear, anal sex has never caused this yet, it's just the Out, not the In that's the issue, it seems...)
mangosorbet007 1st-May-2006 12:59 am (UTC)
Btw, thanks for the reminder about baby wipes! :-)
joybeans 1st-May-2006 01:12 am (UTC)
Wouldn't that be on your anus though?
3_black_cats 1st-May-2006 01:38 am (UTC)
Why does this remind of how my lower lip always gets chapped and splits in the same place over and over?

Hydrocortisone cream is good for a lot of things, but I'd be cautious about using it for long periods of time. Short term, it's great. But I've read that over extremely long periods of time, it can thin the skin and make the problem worse.

That said, (and on a totally unrelated note) I find that a little hydrocortisone cream on my red scaly elbows for a few days makes them look brand new again.

coniglietta 1st-May-2006 08:41 am (UTC)
This happened to me (and still does, occasionally, although not so badly) when my muscles down there were very tight and I also went through a sensitive skin patch. My doc gave me a testosterone ointment to apply, which was meant to thicken the skin a tad? Sounds weird, I know, but it worked. I'd try cortisone creams first, though.
deepbluemermaid 1st-May-2006 12:13 pm (UTC)
I know of two reasons why the perineum might be splitting for no obvious reason (ie, at times when you haven't had a bowel motion or had sex):

- ongoing, low-level yeast
- lichen sclerosus (http://www.lichensclerosus.org/)

I should immediately say that LS is a pretty rare dermatological condition, suffered by both men and women. It can start in childhood or any time in adulthood, but around menopause is more common. The treatment involves steroid creams.

Can I just ask - it sounds like you're definitely able to have intercourse. Is it usually painless, or do you feel painfully stretched? And are there splits after sex?
mangosorbet007 1st-May-2006 06:40 pm (UTC)
Hmmm. The Lichen thing seems to be out, fortunately (still pre-menopausal, no itching, no skin changes, no pain, no anything of the main syptoms).
In any case, sex is fine. As I mentioned in a reply above, I used to have similar problems with my perineum after sex but they went away completely after I went off the pill. My doctor assumed it was either a direct effect of the pill or a secondary effect, due to the lack of natural lubrication while on the pill. Oddly enough I am still a very dry person, and back then, even the liberal use of lube didn't stop the tears.

Now, the yeast thing - how would one test for that? I guess a certain level of yeast is natural and healthy and can't/shouldn't be avoided, and I have a yeast infection maybe every other year or so, much less often than most women I know.
deepbluemermaid 2nd-May-2006 08:25 am (UTC)
I'm glad to hear that LS seems unlikely; it's a hell of a thing to have.

Given your level of dryness, I wonder if a lack of estrogen is the cause. A bit of backstory might help here:

My perineum also used to split if I even looked at it (but, more specifically, it was the posterior fourchette which is the bit connected to the vagina). TUrns out there was a structural reason for that, because it overhung the vaginal opening too much and couldn't stretch. I had surgery to widen the opening, and it's worked well.

Before the surgery, we tried estrogen cream. My specialist believed that being on the pill (especially a low-dose pill) was part of the problem, depriving me of estrogen and thus making the skin more fragile. So I applied topical estrogen cream (the kind used as HRT by menopausal women) every second day for months. It made no appreciable difference, so I went ahead with the surgery. But it might possibly help you...

Yeast can be tested for by a swab. It's also possible to test for systemic yeast overgrowth (ie, right through your digestive tract as well as vagina). Not sure how that's done, though.
bb65 perineum surgery13th-Apr-2013 08:20 am (UTC)
Hello, Could you tell me more about the surgery you had for the perineum? I am thinking that this is the cause of my pain during sex. I am 65 and post menopausal. Thanks
sunnflower05 22nd-Sep-2009 11:06 am (UTC)
I'm 48 and have had a Merina inserted a few months ago . The past month or so I have been getting the perineum tearing during sex which is freaking my partner out , it's just like a paper cut, hardly any blood , but you would think i was bleeding to death the way he carry's on. it is off putting if doing oral i understand that and i cant fully enjoy sex knowing that i may bleed a little. i really don't know what to do either. its not a bother after wards or during, not painful and doesn't feel like it's stretching during sex it feels normal. But I'm sick of this slight bleeding and don't know what to do. i can't relax fully knowing this may tear a little and freak someone out, i have sex regularly 3 -4 times a week so it gets plenty of use so to speak :)
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