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Swollen Mons Pubis
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An_248815 posted:
Hello, I am new to this site. I am at a loss to figure out what is going on with me. I have been having a burning pain in the vulvar area for 2 1/2 years. I was told by my dermatologist that it was my psoriasis. I treated it with Protopic. This burning feeling would be present even without the red rash but they still said it was my psoriasis. The burning feeling along with the red patches spread to my rectal area and I continued to treat it. After two years, I could not take it any longer. It hurt to sit, it hurt to walk, don't even think about sex. It was really hurting my quality of life. I spoke with my dermatologist and she recommended patch testing which showed several allergies and I have changed personal products and the rash in the rectal area is completly gone and the intense burning sensation in the vulvar area is better. While the burning is better, during the patch testing my mons pubis swelled to twice it's normal size. I was told it was an allergic reaction to the patch testing and was given a steroid cream and Nystain for a skin yeast infection that developed in the area underneath my stomach. My entire vulva and vaginal area was swollen all the way back to my buttocks. After five weeks there has been no improvement in the Mons Pubis area, the lower part will reduce but then it will come back. When it first occurred it was swollen both inside and out. I lost feeling in the enitre area. The feeling has come back somewhat but the mons pubis is still swollen at twice its normal size. I went to my gyno because I was having some sharp pains on my left side and wanted to make sure the swelling was not due to a female problem and she said that it was not, everything is oaky in that area. I have fibroids and have previously had cyst and I wanted to make sure that they maybe had not grown and were pressing on something. My gynecologist said that neither a cyst or a fibroid could cause swelling like that and it was not anything girl part related. I went to my primary care and he said that he thought the swelling was due to the cutaneous yeast infection even though the swelling was there before the yeast infection ever showed up. He has given me 10 Diflucan pills to take one a day. I am on day four and I am using Nystatin Gel 1% as well on the skin beneath my stomach twice a day. The red patches underneath my stomach are almost gone but the swelling it still there. About four weeks after the swelling occured in my mons pubis, I developed some swelling in my right leg, mild pain in my groin area and down my leg. I told both my primary care and my gyno about this but both have said that they do not know what is causing it and if it does not go down when I have finished the Diflucan then my PCP will refer me to someone else. I have no idea what to do and I do not know what could be causing this. I have asked what to do for the swelling but no one has any suggestions. I am at a loss and any insight would be helpful. I have spoken with my dermatologist and she says now that the swelling is not due to the patch testing and has referred me back to my PCP for a possible blood clot or infection. I spoke with my PCP and he has said it is not a blood clot and he believes it is the yeast infection. I have no idea how to get the swelling down. I have tried ice packs and I was told not to use heat by my dermatologist due to the yeast infection on my skin. Any ideas on how to reduce the swelling? I have looked on the internet to find out what causes a swollen mons pubis but I have not been able to find anything. Has anybody else ever had this problem? Just wondering .
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Shelcoll2 responded:
I am having the same issues, they just started a few months ago, i thought it was just a simple yeast infection, but i have been on all the meds there is, i am between doctors right now because my doctor shut down his practice, now i have developed a boil and it hurts all the way up my groin. Any suggestions??
 
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Jane Harrison Hohner, RN, RNP responded:
Dear An: Dang, this is one that almost has to be examined. One possibility would be some type of hernia--although the mons is central and most hernias tend to be more toward to groin area. Perhaps there is another type of deep tissue structure that is elevating the entire mons area. Honestly the only time I have seen a badly swollen mons is after some type of trauma--and the swelling is usually temporary.

A literature search at the National Library of Medicine site covered mon's conditions such as: rare types of tumors and a lymphedema. Here is one citation on the later diagnosis:

Ann Plast Surg. 2012 Jan;68(1):101-4.
Massive localized lymphedema: review of an emerging problem and report of a complex case in the mons pubis.
Brewer MB, Singh DP.
Source

Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, 21201, USA.
Abstract

Massive localized lymphedema (MLL) is an emerging complication of the obesity epidemic. Caused by the obstruction of lymphatics, MLL presents as a giant swelling, with characteristic skin changes, and often lymphatic weeping. MLL has also been called "pseudosarcoma" because of its morphologic and pathologic similarity to sarcoma. Left untreated, MLL can degenerate into angiosarcoma. We present a case of MLL of the mons pubis in a 40-year-old man with a body mass index of 69. The literature is reviewed and an additional 40 cases of MLL are described. We found a female predominance of 1.6 to 1, an average weight of 421 lbs, and a 58% majority of cases in the thigh.

Yours,
Jane
 
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LkyLdy1 replied to Jane Harrison Hohner, RN, RNP's response:
I am overweight, but not morbidly so. I am 5' 7" and weigh 220. I have been trying to lose weight. I pulled some muscles back around the beginning of September and this caused spasms all along the right side of my upper torso. The swelling started in the area aroud September 24 and I had patch testing completed due to a rash I have had in my genital area for two and half years that was originally attributed to my psoriasis but eventually was found to be allergic to seven different chemicals and additives which are found in anything from shampoo and soap to toilet paper and maxi pads. After the swelling lasted so long, my dermatologist has now said that it is not due to the allergies. The pain in my right leg is worse, it goes down from my groin and then inside of my thigh to almost my knee and the pain is in my right thigh as well. When I clench those muscle I have pain and I have begun to have pain in my abdomen on the right side as well. The swelling began on the right side of my mons pubis and then spread to the whole thing. When it first started I was swollen inside and out. I had no feeling inside whatsoever. The swelling subsided inside and the feeling has returned (Thank God) and the feeling has returned to the outside on the labia. The swelling sometimes does extend down the vulva almost all the way to my buttocks. I had a C section when I had my son seventeen years ago and I had a drain tube on the right side that had a hard time healing, no infection but took a while. I was wondering if this could be some type of incisional hernia and I have no idea what testing to ask for. Any help or suggestions would be greatly appreciated. I have no idea where to turn. I have been to my dermatologist, gynecologist and PCP and they all performed exams and no one has suggested anything. I would like to thank you for takng your time to answer people's questions. I really do appreciate you.
 
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Jane Harrison Hohner, RN, RNP replied to LkyLdy1's response:
Dear LkyLdy: If there was some type of lymphatic obstruction, or a hernia, a surgeon would be a possible person to evaluate for that. Unfortunately that is the problem with unusual conditions, or unusual symptoms, it can be hard to find someone who is knowledgeable to make the diagnosis.

From what you have shared, your best bet is to try and be seen when the symptoms (especially the swelling) are most apparent (eg when the swelling is from the vulva down to the buttocks). Because I have not personally seen this condition, I can't add much to what I found on the medical literature search.

If you do get a definite diagnosis would you be so kind as to write us all back on this original post so I can find you. Amazingly, another woman with your exact symptoms will find your posts (via your clearly worded subject line) even several years hence. Your experience would be invaluable to her.

In Gratitude,
Jane
 
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LkyLdy1 replied to Jane Harrison Hohner, RN, RNP's response:
Just thought I would give you an update. Called my doctor, explained that I am still having problems. No fever, no redness, would not do a blood test (to check for infection, I thought if the lymph node was swollen due to an infection my white count would be high) but ordered duplex venous ultrasound of my legs, both of them although I do not know why since I am not having problems with the left one. Had the ultrasound on Friday, they said that the doctor would not get the results for 24 to 48 hours. I called the doctor's office at around 2:30 pm and they said that they had not heard anything, (last time I had an ultrasound they got the report in three hours so I thought I would check . They said that they had not heard anything but if I had a blood clot they probably would have heard something that day. The office closed at 3:00 pm on Friday. They said that they should have the report by Monday and will call me. Still have swelling and pain in my right leg and the vulva is still swollen. Since I was getting an ultrasound and taking time off work anyway I said that my swollen vulva is what started this whole thing and it was swollen for five weeks before my leg startd swelling and hurting so I asked if he thought I should have a pelvic ultrasound just to check. The nurse said that she would ask him and if so they would add it and if not I would just get the leg ultrasound. Meanwhile everything is the same, the swelling in my leg is not tremendous and it only affects my thigh area, nothing else. So I still don't know what is wrong and I guess I will wait to hear from the doctor on Monday. I will definitely post back when I found out exactly what is wrong. I just hope I don't have to go through massive amounts of testing to find out. I am wondering though, since my vulva (especially my mon pubis) has been swollen for about seven weeks now should I be concerned about skin breakdown or changes due to the extended period of time? Just wondering. Thanks again for all of your help.
 
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LkyLdy1 replied to Shelcoll2's response:
Shelcoll2,
I wish I had a suggestion for you. I am just clueless at to what to do or say next for my own situation but I will post back if/when I find out what is wrong with me and maybe that will give you some insight on what to do next. I honestly don't know what is causing my issues. I do hope you find out what is wrong with you as well and I hope you can find someone to help you. Hang in there, sooner or later someone should be able to help you. At least that is what I keep telling myself.
Have a good weekend.

An
 
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LkyLdy1 replied to LkyLdy1's response:
The results of the doppler were negative. My doctor has now prescribed Omnicef. I'm guessing he thinks it may be cellulitis? I don't know. I don't think he knows either. I don't like taking antibiotics, especially ones this strong without any evidence of infection (redness, fever) but I have no choice I guess. It is possible to have cellulitis without redness or fever? Even the pain in my leg is not a constant thing but when it hurts, it hurts! My doctor said that if this does not work, I have to find another doctor because this is out of his realm of expertise. He suggested another gynecologist, he feels this is where the problem is, because this is where the swelling started. I just don't know.
 
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Jane Harrison Hohner, RN, RNP replied to LkyLdy1's response:
Dear LkyLdy: Thank goodness it was not an emboli (blood clot) that was responsible for the one sided swelling and pain. My best GUESS is that the broad spectrum antibiotic is for a presumptive diagnosis of cellulitis. Usually there is redness in a more superficial site of infection. It's wise that he is going to refer you on if the antibiotic does not have the desired result.

Shellcol2, if you are still a "boil" with extended borders you should find a general practice MD or clinic. Your condition may actually be a cellulitis, too.

Yours,
Jane
 
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Charna responded:
Wow I never thought I would find anyone that has a similar problem like I have had for the past 18 yrs. Is there any doctors out there that knows how to cure this.I have had to vulvar surgerys due to all the swelling and this condition still returns. They give me cephalexin to help with the swelling of the mons and vulvar area then I get a massive yeast infection that only makes the problem woarst. I wish I had answers for you but thats what I am on her for,looking for answers. It does seem that we have same issues with the Yeast. I am begining to think that it is yeast that is causing this problem.Diflucan is great but be careful it is very bad for the liver.I even moved to a city hoping for doctors with a cure. I will look into the Nystatin Gel and see if that can help me. Thanks You.If you need to talk more feel free to write back.
 
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Charna replied to Jane Harrison Hohner, RN, RNP's response:
Jane hi my name is charna and I have just read the entire articles about this mons problem that LkyLdy1's has been going thru. I am so glad to have stumbled on this. I have been dealing with the same issue now for 18 yrs with no discovery of the reason for a swollen mons an vulvar. It comes and goes as it pleases and I am not over weight at much. I am 5'6 and weight now 150,when this first started I was 185lbs.I have had two vulvectomys in the hopes of curing this. My many doctors have suggested I have cellutlitis and cures it with cephalexin which causes major yeast infections.Then gives me diflucan at the same time I am taking the antibiotic.Many hospital stays because of high fever and this time since swelling is so bad I have lymphatic weeping.In my 40's .How do I control the yeast infections that I get inbetween these infections. Anything other than diflucan(bad for liver) and Yogurt(lactose intolable).I am so inflammed and raw its so hard to use over the counter creams since it burns so bad. Please help.
 
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Jane Harrison Hohner, RN, RNP replied to Charna's response:
Dear Charna: Gosh I cannot believe how quickly your case came to light and joined that of Shelcoll and LkyLdy! Thanks for writing back. It sounds like other possible causes (eg blood clot in pelvic or leg vein, infection) have been added to conditions related to the lymphatic system.

In your specific case your symptoms must have been very severe to merit two vulvectomies. It appears that antibiotics temporarily help--but then the yeast ensues. It also sounds like you have a problem which chronic/recurring yeast between infections.

There is a subgroup of women who have chronic and recurrent yeast infections. It is important to document that these infections are truly candida (yeast). Other infections such as lactobacilli vaginitis can masquerade as yeast, but yeast medications will NOT provide any lasting relief. Certain dermatologic conditions of the vulva can have symptoms which mimic yeast (eg lichen sclerosus).

If a woman has proven recurrent yeast, by either vaginal fungal culture or wet mount preparation, then some additional testing can be done to see if a predisposing medical condition (eg diabetes, HIV) is the culprit. In your case I would suspect this has already been done.

Women with chronic yeast may be treated with a variety of options. A change of prescriptive yeast treatment may be tried. Preventative treatments may be used around the time of menses every month--if that is when you have the flares. Use of other medications which can predispose women to candida (eg steroids, chronic oral antibiotics, or even birth control pills) may need to be re-examined. Some healthcare providers will use treatments like vaginal boric acid capsules for either treatment or prevention in the cases of resistant vaginal yeast.

" Lifestyle" changes may be initiated.Lifestyle methods, which have been advocated for "yeast infection prevention," include: a diet low in refined sugars and simple carbohydrates, avoidance of tight jeans, use of cotton underwear, and others. There are few, if any, good research studies which demonstrate that these methods are helpful, but some women swear by them. There is even the suggestion that being the recipient of oral sex may predispose a woman to recurrent yeast (Reed, 2000).

With the over the counter creams you might be a better candidate for the seven day regimens rather than the three or one day versions. No matter which regimen you use you will receive the same total amount of active anti-fungal. But in a seven day regimen the dose will be less (hopefully less irritating) than getting the whole dose in one day. Another thing to evaluate is the inert ingredients used in each product. One product may have more irritating effects in the vehicle which is used to make the cream or gel or ovule.

In Support,
Jane
 
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Shelcoll2 replied to LkyLdy1's response:
Thanks trying to find out! this is ridiculous, i haven't had a problem before, it just started in october 2012!
 
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Shelcoll2 replied to Jane Harrison Hohner, RN, RNP's response:
Well i went to my doctor and she put me on the yeast infection pill for 3 days, Well it did help for a week, now it's back, i have serious itching, but not really bad swelling, I don't have insurance so getting a whole bunch of tests! This is awful!! I have no pain in my legs or anything!
 
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Shelcoll2 replied to Jane Harrison Hohner, RN, RNP's response:
don't have the boil anymore it went away with antibiotics, I am now just dealing with this itching that comes and goes, i was just on the yeast infection pill for 3 days and it helped but it's back, i'm lost, i don't have insurance so i really can't afford to have a bunch of tests!


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