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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html