I have an area right beside the opening of my vagina where the skin is so thin it tears whenever I have sex. Three weeks ago, I went to my gynocologist and she did a vulva Keyes Punch biopsy. I went back last week to get the results of the biopsy and was told the lab had "lost" my biopsy and I would need to have it done again. The doctor told me it looked healed and I could go ahead and start having sex again. She said she wants to give me a strong steroid cream to thicken up the skin but has to rule out any chance of cancer before she can. I told her I would be back in to get the second biopsy in a week or two after I got through some personal matters. I am still sitting on a donut cushion from the biopsy! I tried to have sex but it was too painful and it bled. I am concerned now that I may always have problems from the damage of the first biopsy and not be able to have sex again! I feel like I should get a second opinion but cannot get an appointment with a new doctor for some time. I am 63 years old and have had a problem with my skin tearing there since I was in my 30's. I also have Sjogrens Syndrome. My doctor said she is suspicious of Lichen Sclerosis. Is this normal procedure?? What kind of damge could a second biopsy cause? Please give me some guidance here! Thank you.Rebecca VentressXXX-XXX-XXXX cellemail: XXX@XXXXXX.XXXwork email: XXX@XXXXXX.XXX
Hello, and thank you for your question. I will be happy to assist you. Answers are for educational purposes only.
Hi, I am sorry to hear about the difficulties that you are experiencing. I can only imagine how frustrating that is for the lab to have lost the biopsy. It is rare, but it happens from time to time. I do agree with the need for the biopsy. Given you menopausal status and your history of sjogrens, it is very possible that you have lichen sclerosus. It really should be diagnosed by biopsy, and although rare, an underlying cancer can be present and should be ruled out. There are other dermatologic conditions that can also cause these changes, so the biopsy would be helpful in identifying an alternative possibility as well. Unfortunately, biopsies can take some time to heal. Your doctor is going to have to biopsy a different area for the repeat biopsy, so you can go either way regarding waiting for the first biopsy to heal or not before doing the second biopsy. Some things you can do to help the healing process of the biopsy site is the application nightly estrogen cream (premarin). Also, you can keep it moist during the day wih aquaphor vaseline. if it is painful, then you can try xylocaine jelly (anesthetic vaseline, by prescription) instead of the aquaphor vaseline and apply that during the day. It will keep it moist, and dull the pain.
Ultimately, you will very likely be able to have sex again. It is probably just too soon. You need to have the condition adequately treated first. The lichen disorders (lichen planus is also a possibility which the biopsy can detect) can take some time to improve with the steroids. Typically I treat it with the steroid cream twice a day for a month, then taper it down so that eventually, you are using it once a week as a maintenance therapy. Most women do well with this and can resume normal activity. So please try to be patient with it. The lost biopsy is definitely a bump in the road, but until the diagnosis is confirmed and treatment initiated, it is too soon to make any long term conclusions. I hope this is helpful. Please let me know if you have any follow up questions and I will be happy to answer them. Thank you. Positive feedback is greatly appreciated.
Board Certified OB/GYN and accomplished educator