Dear Doctors: I've read your column for years but have yet to see anything about my problem. I tend to sweat a lot, not under my arms, but in my crotch area. It's embarrassing and even causes me to get a lot of UTIs. I've tried panty liners and medicated powders, wear only cotton underwear, but nothing works. I'm so frustrated. What can I do?


Dear Reader: Excessive sweating that isn't a response to either heat or exertion is known as hyperhidrosis. When sweat glands are overactive in one specific location, it's referred to as focal hyperhidrosis. The condition is believed to arise from overstimulation of the sweat glands by the autonomic nervous system, although why this occurs is unclear.


Excessive sweating in the armpits and around the head and face are the most common types of hyperhidrosis. The folds of skin beneath the breasts are another area of focal hyperhidrosis. Although less common, sweating in the area of the groin is a problem for many women. Researchers recently conducted a survey of close to 2,000 adults who are registered users of the International Hyperhidrosis Society website, found at sweathelp.org. In that survey, 43% of respondents reported experiencing excessive sweating in the groin area.


Our bodies use sweat to stay cool. When certain physiological signals let the brain know the body is at risk of exceeding its optimal temperature range, they direct the sweat glands to release moisture. This results in an evaporative effect, which helps to cool the skin and regulate temperature. And while sweating in the crotch area is a normal function of this cooling system, sometimes the signals go awry.


Some women find relief with topical antiperspirants. These use chemical compounds to temporarily plug the pores through which sweat exits and reduce the amount of moisture that is released. However, antiperspirants can be irritating to delicate skin and tissues, and they should be kept away from the vagina.


Two therapeutics, which have been approved by the U.S. Food and Drug Administration for excessive underarm sweating, are finding off-label use in other types of focal hyperhidrosis. One, a prescription medication called Qbrexza, is a premoistened towelette saturated with a medication. It is applied once daily to the affected skin. Also approved for excessive underarm sweating is Botulinum toxin A, more widely known as Botox.


Some physicians are reporting success with off-label uses of these medications, including for hyperhidrosis in the crotch area. However, it's important to understand that neither of these medications are FDA-approved for hyperhidrosis in any region other than the underarms. When it comes to Botox, the amount of the drug required for the crotch area can make the treatment quite costly. It's also very important that the physician providing the treatment is well-versed in the specific injection strategies that are being pioneered.


If you haven't already, please consult with your health care provider. They can help you with strategies to lessen the incidence of UTIs and other infections. They can also offer guidance if you choose to pursue other options.


Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. They can be contacted at Ask the Doctors c/o UCLA Health Sciences Media Relations, 10880 Wilshire Boulevard, Suite 1450, Los Angeles, CA 90024, or by email at AskTheDoctors@mednet.ucla.edu.