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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 1982
Experience:  29 years of experience and an award-winning educator.
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I have a vaginal tear on the outer lip of my vagina. It is

Resolved Question:

I have a vaginal tear on the outer lip of my vagina. It is sensitive when it is touched but I am not in pain, I am not in pain when I urinate and it isn't in a cluster. It's just the one tear. I also have what appears to be a tear on my anus. Again, it does not hurt when I use the bathroom and there is no cluster. I do not have flu like symptoms but I did just finish taking medication for a yeast infection. Could this be herpes?
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.

Dr. C. :

I am glad to help you. Answers are intended to provide general medical information only.


 

Dr. C. :

It may be an "atypical" herpes but can be other things too.


 

Dr. C. :

Sometimes we see skin splits like you're describing from 2 other common conditions. The first is thin tissue from low estrogen levels. This can be found in women who are thin, on hormonal birth control or in menopause. We usually will treat this by using a local topical estrogen cream. The second condition we see commonly that causes tears are various dermatosis. These are basically skin conditions such as eczema & psoriasis. The one most commonly seen in the vulvar area is a condition called lichen sclerosis. The treatment is a steroid cream.


 

Dr. C. :

It may be helpful to have a biopsy done of the skin split to be able to tell the difference between those 2 conditions so the right treatment can be given. Or if a woman fits a profile that makes it obvious, treatment can be started without a biopsy. For example in a thin women who is on low dose birth control pills, it would be reasonable to just try adding estrogen cream applied to the tearing areas nightly for a few weeks to see if that helps.


 

Customer:

what do you mean by "atypical" herpes?

Dr. C. :

Sometimes with lichen sclerosis or other dermatosis, there will be other skin changes visible on exam. Lichen sclerosis is more common in women who are older, nearing or in menopause. But it can also be found in younger age groups.


 

Dr. C. :

Some herpes doesn't look like typical herpes, the clusters of shallow ulcers that are typically seen.


 

Dr. C. :

A viral culture can be taken from the split. If it's positive, then it's atypical herpes.


 

Customer:

well I just finished taking medicine for a yeast infection (monistat) and these symptoms appeared a day or two after I finished

Dr. C. :

If the culture is negative, it may still be herpes. The virus is hard to grown so sometimes cultures will be negative even though its herpes.


 

Dr. C. :

It may be just in reaction to the medication.


 

Customer:

even if I have taken monistat before?

Dr. C. :

Some women are allergic to the base the medication is put into.


 

Dr. C. :

Yes it's still possible.


 

Customer:

are vaginal tearing and anal tearing common with yeast infections?

Dr. C. :

If this is the first time the splits have happened, it would be fine to use a mild over the counter anesthetic gel like Oragel to help with the pain and see what happens.


 

Dr. C. :

No not very common but we do see it when a yeast infection is bad. The infection can weaken the skin tissue and cause tears.


 

Customer:

are these tears I am describing, without any pain, common with herpes?


 

Customer:

I am just trying to get a better idea of what it is? if it's from the yeast infection or if this is an outbreak of herpes

Dr. C. :

But if this bout heals but than comes back, it is probably not related to the yeast. It's not a common way of herpes presenting but we do see it.


 

Dr. C. :

Let me see if I can find a percentage of herpes cases that present "atypically".


 

Dr. C. :

There is no statistic that I can find on this. The reason is that most people who have herpes don't realize it.


 

Dr. C. :

Herpes does sometimes flare when there has been a yeast.


 

Customer:

what would the differences be between a vaginal tear and a herpes lesion?

Dr. C. :

Getting a blood titer test for herpes may be helpful in this situation.


 

Dr. C. :

A vaginal tear is just what we see, a tear in the tissue. But the cause of the tear can be lack of estrogen, a dermatosis, herpes, etc.


 

Dr. C. :

So the tear is the symptoms but herpes would be just one possible cause.


 

Dr. C. :

If blood titer for herpes is negative now, it can be repeated in 3 months. If its still negative than this is not herpes.


 

Customer:

and how would you describe a herpes lesion?


 

Dr. C. :

Typical herpes is a small shallow ulcer that is painful. They can have slightly irregular edges and join together with other lesions. They can be red and are almost always quite painful.


 

Customer:

oh ok

Dr. C. :

Linear splits are more commonly thin tissue from low estrogen or a skin condition as I've described above.


 

Dr. C. :

But getting a herpes culture off the lesion and/or blood titers may be helpful to be certain. It's also possible that a doctor taking a complete history and examination may be able to tell better which is the cause of the splits.


 

Customer:

after getting a herpes test done, will they be able to clarify if its type 1 or type 2?

Customer:

and if you have type 1, is it easier to get type 2?

Dr. C. :

Yes we can test for both types, the name of the test to get is "IgG type specific titers".


 

Dr. C. :

But 50% of the population is positive for type 1 and type 1 can get transmitted to the genitals. Herpes is one of the more confusing things to tease apart sometimes.


 

Dr. C. :

The thing that is most helpful in making a sure diagnosis is if the finicky virus does grow positive on a culture swab taken off the lesion.


 

Dr. C. :

Besides that, we try to put it together the best we can. But if a person happens to be negative for both on blood titer and again negative on both in 3 months that again we can be certain that its not herpes.


 

Dr. C. :

than


 

Dr. C. :

Anything else I can clarify?


 

Dr. C. :

I'd like to be sure you get excellent service so please do ask.


 

Customer:

I believe that is all, but in your opinion from what I described and considering I have no pain while using the bathroom or in general, do you think it's herpes?

Dr. C. :

It is more likely NOT.


 

Dr. C. :

I would be more sure if I had more history and able to examine obviously.


 

Customer:

of course. well thank you very much

Dr. C. :

Ok, I hope this was helpful.


 

Dr. C. :

Please ask follow-up questions into this same post if you think of any later. I'd be happy to clarify any questions that may pop up later too.


 

Customer:

ok, thank you

Dr. C. :

You're welcome.


 

Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 1982
Experience: 29 years of experience and an award-winning educator.
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Dr. C.
Dr. C.
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29 years of experience and an award-winning educator.