Dermatologist for the Downstairs!
When I used to think of the dermatologist, I thought of the two areas I’d seen one for…skin cancer screening and treatment of adult acne. A dermatologist by definition addresses issues with the hair, skin and nails. BUT did you know that some dermatologists specialize in the pelvic floor regions?!?
The genital region is only about 1% of a person’s total skin surface area. When there is a problem with the genital skin, it can be really uncomfortable and hard to ignore. There are certain diagnoses that can affect a person’s skin that a pelvic health practitioner may also help diagnose and manage. These include conditions such as Lichen Sclerosis, Lichen Simplex Chronicus, Lichen Planus and Genital Herpes to name a few that can be trouble makers for the pelvic floor.
Pelvic Floor Physical Therapists can help with a lot of things. A PFPT can provide recommendations on proper skin care of the perineum to allow this skin to be as healthy as possible. See the chart below for good care and practices versus activities to avoid!
| Good Care and Practices | Activities to Avoid |
| Specific perineal cleansing with lukewarm or cool water only and using the fingertips, not a wash cloth. Pat to dry, do not rub. | Avoid washing or cleaning out the vagina (douching). Do not use hot water, include deodorant soaps, bubble baths, shower gels, talcum powder, cleansing wipes, perfumed soaps and washes, deodorants and antiseptics. |
| A Peri-bottle (squirt bottle of warm water) can be used to clean after urination or a BM to minimize irritation from wiping. A peri-bottle can also be used after sexual activity. | Do not wipe aggressively. Do not wipe back to front! |
| General bathing with fragrance free pH neutral soap | Avoid using soap, cleansers or body wash in the perineal region. If you must use a cleanser, do so over hair bearing areas and with an unscented cleanser such as Cetaphil or Dove. |
| Washing clothing with unscented detergents and double rinsing | Washing with scented detergents, fabric softener, items with fragrance |
| Loose fitting pants, skirts or athletic wear | Extended wearing of jeans or other tight pants, swimsuits, leotards, thongs or lycra garments |
| Use cotton material for undergarments and feminine hygiene products | Synthetic underwear, pantyhose and tights, non-cotton lining on menstrual pads |
| Alternate sitting activities with movement and standing. Use of ergonomic seats and cushions with prolonged sitting. | Prolonged pressure on the perineum, uncomfortable or poorly fitted chairs or bicycle seats |
| Fresh air is necessary for a healthy perineal region, try sleeping with no underwear to allow the vulvar area air | Hair removal techniques (shaving, waxing, depilatory creams) can also increase irritation and are not necessary for increased air flow. |
Sometimes, there are more complex skin issues that need further medical intervention than just basic skin care. A Pelvic Floor PT can detect skin issues early and refer to the right provider to ensure the proper skin care is provided.
Tips to Find a Dermatologist for your “Downstairs”
- Call around to a few different providers
- Ask practitioners about their experience treating the perineal skin
- Ask other health care practitioners for a referral: ex gynecologist, urogynecologist, Pelvic Floor PT
- Listen to your gut – if you like someone great… if not, keep looking!
- Don’t be afraid to get a second opinion
- If you know other individuals with a similar diagnosis ask their experiences with providers
Finding the right practitioner in any case is very important, but especially when it comes to the perineal skin!
Practically Yours,
Dr. Mo
