In a message dated 10/7/2004 5:22:14 PM Pacific Standard Time,
[log in to unmask] writes:

I received a call from a G3P3 who is having extremely painful intercourse.
She states that her physician prescribed a topical application of
Betamethasone which provides some relief as long as she uses it. She was
told she may have to stop breastfeeding because it is the hormones of
breastfeeding that are causing this problem. Her perineal area is reddened
when she does not use the cream. I suggested that she call a dermatologist
she sees and that I would post to you. She has had one period and the next
one is due in about 2 weeks. Any thoughts?
The differential diagnosis for these symptoms are:

atrophic vaginitis
bacterial vaginosis
vaginal candidosis
lichen sclerosis or lichen planus
or a combination of these factors.

Atrophic vaginitis can be caused by breastfeeding since estrogen levels are
lower UNTIL menses resumes.  The treatment is estrogen orally and/or a cream.
If this is the cause I would recommend the vaginal cream twice weekly for a
month then weekly as needed.  Since her menses has resumed her estrogen levels
should returning to normal on their own--but it can take a few months for the
tissue to heal.  Using the cream will speed up healing. FYI---The hormones of
breastfeeding don't cause atrophic vaginitis but they do cause amenorrhea and
lowered estrogen. Nonetheless ceasing breastfeeding is unnecessary particularily
in a women who has already resumed her menses and when we can treat with some
topical estrogen. I don't think ttopical estrogen will have much of an effect
on her milk supply but she should be informed of this possible side effect.

If she had not had cultures for bacteria and yeast run then this is
important.  Treatment then is obviously based on the results. Yeast and bacterial
overgrowth can present with redness and soreness as the only symptoms.

Lichen sclerosis/planus are both treated with steroids which she is already
on.  But if this is the diagnosis I usually recommend she be seen by an OB and
have the area biopsied as they can mimic cancers.

Christine Betzold NP IBCLC MSN

www.theBFclinic.com

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