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Perineal itching

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I have been experiencing a pretty constant itching, sometimes sharp, sometimes tingling sensation in the vaginal and rectal area. I tested negative for chlamydia, ghonnorea and any bacterial infection in the vaginal area such as yeast infection or bacterial vaginosis. I went to a proctologist and he said the anal area looked normal as well just a little inflamed on the outside and gave me some ointment to put on it. I also tested negative for any parasites or pinworms.

I have not been tested yet for herpes because my obgyn said the tests can give a false positive a lot of times and it scares people so unless I have a sore down there then I'm probably fine. I don't have any sores and have been looked at recently by an obgyn but the itching and tingling is continuing and I have no answers as to what it is. If it was herpes would this itching/tingling feeling be in a very specific area where the outbreak was about to happen or does this all over general itching in the vagina and anus sound like it could be the first symptoms to a herpes outbreak?

Any other insight as to what could be going on?


Category: OBGYN

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Category: Infertility Specialist
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Welcome to DoctorSpring.

Thanks for writing to us with your health concern.
The primary four conditions to be ruled out for perineal itching are - yeast, BV, chlamydia / gonorrhoea and worms.
All these 4 have been conclusively ruled out in your case.
Yes, there is no sense in being tested for herpes unless there is a sore.
How long have you been having this itching and tingling ?
It is prodromal symptom of herpes, but yes, it would be in a specific localized area where the sore was about to appear, and not generalized all over.
Also, it is generally the initial symptom, and a sore or outbreak would soon follow.
Apart from what you have been tested for, it could be folliculitis.
This is a lingering infection in the hair follicles of the perineal area.
You can shave yourself all over if you havent ( if there are no obvious pus filled bumps only then should you shave ).
ALso, do not use any gels / cleansers / douches / soaps as they would further disturb the vaginal flora.
Just shave thoroughly and clean yourself with warm lukewarm water.
Wear cotton undergarments and change frequently in the day to keep yourself cool and dry.
Have protection during intercourse till the itching clears off.
Use a local anesthetic ointment around the anus, as by itching over the peri anal area and then itching over the vaginal area, you would be introducing infection from one part to the other.
Also it could be allergic itching from toilet paper / sanitary napkins / tampons / soaps / latex in condoms / synthetic underpants etc.
Dryness in the area too can cause itching.
Just use the ointment prescribed for the peri anal region and aloe vera gel for the vulval area.
All the best.
Please feel free to discuss further

Thank you

Patient replied :

Thanks you so much for your response. This generalized tingling and itching in the vaginal and anal area has been going on for about a week or so. Some slight lower abdominal cramping has been happening too but I don't know if it's just because I'm paying attention to every little symptom now and freaking myself out. I also heard anxiety can make this type of itching worse and I've been extremely anxious about all of this. It seems like everything has been ruled out, basically the only thing I could still do is switch toilet papers but I have been using this tp for years and never experienced anything like this. I will still try that though.

The proctologist gave me an ointment that's for things like diaper rash and stuff to put externally on the anal area. It numbs and cools it down temporarily but the itching and tingling comes back. It's very frustrating. I've been looked at by an obgyn, a doctor, physicans assistant and proctologist and none of them mentioned seeing any sores. They actually all said that everything looks normal. The obgyn just said he noticed some clear yellow discharge with no odor and said maybe BV, but my culture from the doctor already came back as negative for anything like that.

So you don't think this sounds like the herpes thing right? Since it's been going on for a week and still no sores and the itching and tingling is quite all over and not in one specific area.

Thanks so much!


It does NOT at all sound like herpes, just do not worry.
WIth all workup normal, yes the only possibility left is that of psychological itching, due to anxiety or some other psychological issues.
I think you have way too much insight for that to be happening.
Why not consider that as a possibility.
All that remains ( with all negative evaluation findings you are reasonably certain there is nothing serious to worry about ) is to stop the itching.
ITching leads to irritation of the skin, rendering it to further itching ( the notorious ' scratch - itch ' cyle ).
Applying ice packs, or a local numbing ointment will help to control the itching.
Oral anti itch medications such as Cetirizine can also be taken.
Just avoid spicy, greasy food, it can sometimes cause a peri anal itch.
All the best and take care.

Patient replied :

Thanks again. Your advice will probably help me to relax! One other thing I've thought of is that I'm allergic to my toilet paper. I have been using this same toilet paper for quite a while but do you think there is a possibility of developing an allergy to something all of the sudden? I use Charmin ultra strong which I've researched has several ingredients in it that could cause people irritation. Do you have any suggestions on the kind of toilet paper I should try switching to as far as natural or hypo allergenic? Thanks!

Hello again,

Try switching the brand as nothing else has helped.
Try using the Seventh Generation hypo allergenic ones .

Take care

Dr. Aarti Vazirani
Category: Infertility Specialist
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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