Everlasting Burning

[MarieDG]

I am a 54 y.o, menopausal/premenopausal.  I have severe vaginal burning sensation in the region of my cervical neck.  In other words, located deep in vaginal area.  No burning on outer area of vagina or on urination.  The problem first presented last year when I had problems with trickling urine throughout my day.  Not enough to wear "Depends" but enough to notice the smell of urine in my underwear after 4-6hrs. I was seen be a urologist who told me my urethra was too small, preventing me for completely emptying my bladder.  A dilation was done in his office.  When I went home, I noticed that I was bleeding from my urethra and vagina.  I called the urologist and he said it was common.  I was mystified, but I let it slide.  As I mentioned before I am menopausal/premeopausal, meaning that I sometimes have menses that are heavy and sometimes lasts for a month or longer, sometimes shorter.  I  noticed that during my menses, I had bleeding from my ureter as well.  During the time between periods, and even skipped months I have this severe burning.  I also notice what seem to be urine coming from my vagina.  Could something have gone wrond during the dilation that cause urine and blood to go both ways.  I am presently seeing my GYN and URO but am yet to get a solution to this problem that keeps me up most nights.  p.s. no vaginal dryness.  Was on Estrogen but had to stop because it lowered my BP.

Thanking you in advance.   MarieDG

[Elaine Brown, MD]

Hi!
The first thing I would address is your prolonged/irregular cycles.  I would attempt to convince you to let me do an saline ultrasound-guided/ endometrial biopsy and a pap smear.
I ALWAYS recommend a pregnancy test too, although I think that is pretty UNLIKELY in this case.  
I would want to do the ultrasound to evaluate your uterine lining, and  unless the endometrium (lining) is very thin (less than 5 mm) a biopsy should be done to rule out cancer/hyperplasia/polyps. The type of bleeding that you are having is not normal, even at 54!
I would also do cultures from the vagina/cervix and urethra to rule out infection.
This would include a urinanalysis and urine culture as well.

A dye study( either in the office or using X ray) could rule out a fistula(communication) between the bladder and vagina.  It is probably much more likely that you have a little stress or urge incontinence causing your symptoms though--Many women do when they become peri/post menopausal.
It is possible that you have atrophy--that is thinning of the vaginal/bladder/urethral lining due to low estrogen levels.  This is probably the most common cause of "burning" type discomfort. There are several tests to rule this in or out.  If your problem got worse after stopping the estrogen, this is quite likely the issue.
It is also possible that you have a urethral caruncle which is basically a polyp at the opening of the urethra.  If so, the urologist would know the best way to treat that.  Topical estrogen often works pretty well.
If we had done all of these tests and still found no cause, I would turn you over to the urologist for a possible cystoscopy (looks inside the bladder).
i hope some of this information is helpful!
Dr B

[MarieDG]

Thank you for responding. I have had uterine biopsies, although not the saline ultrasound guided, results were always negative, another due in December.  I have had ultrasounds, pap smears, cystoscopy, results are all negative. Not sexually active or pregnant either.  I will try the dye test through my urologist.  Hopefully, this will shed some light on this problem.  If you think of anything else, please let me know.  Thank you again.