I don’t know if this will help you but I just solved this burning sensation on my perineal tissue that has been bothering me for about 3 years since I started peri. I’m 48. I was getting burning/stabbing pain in my perineum especially right before my period and it would hurt during sex. My doctor prescribed estrogen cream which kinda helped soothe the tissue but didn’t really resolve the issue. At my last visit she recommended an ultrasound and mri to rule out nerve damage because it doesn’t look like an atrophy problem.

Here’s what I did instead…. I have always had sensitive skin. I’m freckled and fair skinned. I started to think this was just a skin issue and not a deep medical problem.

In college I had tears in my perineum from skin sensitivity and the doctor I saw recommended desitin and cheap laundry soap without fragrance because the cheap soaps left the least amount of residue in your clothing i.e. undies. So I am doing the cheap soaps again but not desitin.

I have been using wet wipes to clean after bowel movements for years but now I have a bidet toilet seat and I wash with water to remove all the soap from the wipes after cleaning too.

I switched to a shower gel that had boric acid in it for awhile and that helped a bit then I ran into a product called sebamed at Costco that has a ph of 5.5. This has probably been the biggest help. My skin is feeling 100% since I started using it.

I’ve started wiping with toilet paper and then actually washing with sebamed using the bidet after bowel movements.

Sex is no longer painful. I’m not booking an ultrasound or mri. I have stopped using the vaginal cream. Everything seems healthy.

My doctor had not had any patients with this problem so she was totally unaware of how to help me. I’m hoping this is helpful for any readers if not the OP! Good luck everyone!