What Causes Burning Feeling Around Genitals And Discomfort After Urination?

Posted on Tue, 6 Jan 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 6 Jan 2015 Answered on

Tue, 27 Jan 2015 Last reviewed on

Question : Female age 67. I have had flare ups of extreme burning and pain at the meatus and surrounding vulva on and off for 11 years. I can remember the exact day in Dec. of '03, it hit with no warning and has been with me at some level ever since. We lived on a canal in the intracoastal waterway on Padre Is. by Corpus XXXXXXX and swam in the canal water, I have only added this since my husband insists that I might have picked up some kind of "bug" that way. Dr.s there didn't think so. I have been to every specialist I can think of, had biopsies of the urethra and labia - results were inflammation of tissue samples, urinalysis almost always neg for bacteria. Have had a total hysterectomy 10 yrs. ago. I am currently experiencing an EXTREME flare up (the best way to describe it would be exposure of the urinary meatus and surrounding vulva to the bites of fire ants) after several years of mild symptoms, but almost always a slight discomfort especially AFTER urinating. Wondering if this could be Strep D? (read about this recently). Is group D strep tested for on routine urinalysis? I am a nurse, so am trying to figure this out since no one else seems to be of help. Sometimes I experience chills and with this current episode I had rigors for several hours, and my husband insisted on taking me to the ER. All tests were neg. including blood cultures and the only abnormal lab was an elevated lactate level. Please help, I just don't know what to do anymore and I am otherwise an active healthy individual with a positive outlook on life. This time it's bringing me to tears and my only relief is if I keep an ice pack on my vulva. I don't want to take heavy duty pain killers, I just want to know what is causing this. The other question is, is it possible to be sensitive/allergic to your own urine or vaginal secretions? This is what it seems like. Thank you so much for any feedback you might have. XXXXXXX YYYY@YYYY

Answered by Dr. Dr. Rakhi Tayal (-4 hours later)

Brief Answer:
Nerve irritation likely.

Detailed Answer:
Hello,
Thanks for trusting us with your health concern.
The pain and extreme burning that you are having can be due to an infection or due to a nerve related cause. Group D strep is not tested on a routine urine analysis but it can be detected on a urine culture.
The more likely cause is a nerve root compression or irritation at the level of coccyx or pudendal neuralgia. This can be detected on an MRI scan of the lower spine. Medicines like methylcobalamin supplements and pregabalin or gabapentin can help you. Do consult a neurologist for the proper guidance. Applying counterirritant creams on the vulva can also help.
Please feel free to discuss further. I will be glad to answer the follow up queries that you have.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Rakhi-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (20 hours later)

Thank you for your reply. I did have an MRI of the coccyx area several years ago which was normal. How do you detect pudendal neuralgia? I will explore the use of the medications that you have suggested with a neurologist. What are the names of the counterirritant creams that you mentioned? I took an antihistamine, 10mg cetirizine hydrochloride, last evening and it seemed to finally give me some relief and I slept well for the first time in many days. Could this mean that I am allergic to something down there? I don't think it's anything in the environment, don't wear underwear other than cotton, double rinse clothes, don't use soap on the perineum, etc., etc. My urine pH is always elevated and the burning of the urethra and vulva ALWAYS increases after urinating and lasts at this higher level for 30 min or more, could this be a sign of anything? I sincerely appreciate your thoughtful and helpful reply. XXXXXXX

Answered by Dr. Dr. Rakhi Tayal (52 minutes later)

Brief Answer:
Do consult a neurologist.

Detailed Answer:
Hello.
Thanks for writing again.
Pudendal neuralgia diagnosis is usually made based on the patient’s symptoms, history, and exclusion of other illnesses such as infection or tumor. While no test is 100% accurate some of the more commonly used tests are the pudendal nerve motor latency test (PNMLT), electromyography (EMG), diagnostic nerve blocks, 3T MRI using special software and settings, and magnetic resonance neurography (MRN).
The counterirrtant cream available is Capzasin - P cream - It contains capsaicin. It can cause irritation locally. It is best to use it after allergy testing and start with less than pea size amount. Zinc oxide cream can also help.
Allergy to toiletries is also possible. Using a pH balance vaginal wash like Vagisil will help.
Do keep the area well moisturized with a good quality moisturizer or vaseline.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar