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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 years of experience and an award-winning educator.
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Dear Doctor, I am a 61-year old Registered Nurse in general

Customer Question

Dear Doctor,
I am a 61-year old Registered Nurse in general good health with no chronic illnesses. In 2000 I was, sadly, infected with HSV2. I have been on Valtrex 500mg qd almost steadily since then. I have not been sexually active for over 4 years. About 10 days ago, I discovered that Valtrex might be responsible for my tinnitus, so I stopped taking it. When the tinnitus did not disappear, I went back on my Valtrex. About two days later, I got a nasty case of perianal itching that moved to my labia majora on the right. This has happened before, but I never considered that it could be an outbreak. Now, I believe I have seen a few rashy lesions on the labia, and I have developed a watery slightly yellow vaginal discharge. I think this might be an outbreak, but, as you know, the symptoms of HSV2 are frustratingly vague sometimes.
I have called several GYNs in my area, but none are able to see me in a timely manner. I know how busy they can be. I would probably ride this out, but I noticed something that has me a little scared. When I was examining myself for lesions, I noticed that some of the tissues at the opening of my vagina are very pale, almost white including the flesh surrounding my urethra. This doesn't seem normal to me. So, in the absence of an exam, do you feel that the pale color of these tissues is normal, and does my above description sound like a herpes outbreak to you. (I will, of course, go to my GYN next Thursday, but that's a long time to be frightened.) Thank you for your time!
Eve, RN
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. C. replied 1 year ago.

Hi, It's Dr. C. Board certified Ob-gyne with 30+ years of experience. I can help you today.

I'm sorry that you're having this trouble right now. White tissue in the genital region that causes itching is consistent with a fairly common skin condition called lichen sclerosis. Also menopausal thinning can cause paleness of the tissue plus itching. If possible can you attach a photo using the paperclip icon on your screen? To test out the theory of lichen sclerosis, you can try an over the counter hydrocortisone. If that helps at all, it's consistent with that diagnosis. But obviously you'd need an exam to verify what really is going on. Lichen sclerosis can cause intense itching, white patches and skin splits in the labial folds.

I hope this was helpful.

Expert:  Dr. C. replied 1 year ago.

I got a notice that you've replied but I don't see your response. Can you please re-type it?

Expert:  Dr. C. replied 1 year ago.

I noticed you've re-posted your question. Rather than have 2 questions going at the same time, I can opt out to allow other doctors to read this thread and provide their opinions.

In the meantime, is there anything that I can clarify or provide more details about?

Expert:  Dr. Thomas, MD replied 1 year ago.

Hello

In fact lichen sclerosis is a relatively serious condition and you should not try cortisone on your own.

Bad idea.

Cortisone would also clear up many other problems temporarily.

It is not a diagnostic tool.

You don't have to see an OB gyn.

See an internist if one is more readily available, or a family practice doctor.

Expert:  Dr. C. replied 1 year ago.

On the contrary lichen sclerosis is a fairly common chronic skin condition of the vulva that we see nearly on a daily basis. The main differential diagnosis for pale tissue in the area described are lichen sclerosis and atrophic menopausal changes. Both cause pale or white tissue. Over the counter steroid would not be helpful for atrophic conditions and would in fact cause a slight worsening of the symptoms while it would likely cause an improvement in lichen sclerosis. As I said in my original response, the only way to tell is to be examined. But it's not likely that there is anything serious. If exam and/or biopsy does not confirm lichen sclerosis, the treatment of choice is likely to be topical estrogen. Atrophic vulvovaginitis can cause both pale tissue and a watery yellow discharge. It's also possible that this could be a variant of herpes. As the immune system weakens with aging, sometimes herpes gets harder to control. I do believe that a gynecologist is the best choice to tease apart what is happening. Please reply if I can clarify anything else.

Expert:  Dr. C. replied 1 year ago.

It's Dr. C. checking in on how things are going. Did you have any further questions? I hope the information helped with some of the worry until you can get in.