Aunt Vadge: cuts and tears continue, despite all bases being covered

Hi Aunt Vadge,

I’m 23 years old, from the south east of England, and have been sexually active with men for just over a year. The problem is I’ve been having a problem with recurring fissures in my posterior fourchette and labia now on and off for 11 months. They started a month into my current relationship at the end of February 2015, at the time I carried on having sex with my boyfriend daily although the pain became quite unbearable as I just thought it was a side effect of thrush. However the thrush cleared up and I examined myself, and I noticed a tear on my labia minora. 

I went to the GP in May and had a full sexual health screening, was given the all clear, and told to have a break from sex. My boyfriend and I would have a couple of weeks break but whenever we started having sex again I always bled and it hurt.

Finally over the summer I had a 6 week break from sex, tampons, sex toys ect. I went back to my doctor in September who said the wounds were almost healed and she gave me a steroid cream that I applied every day for two weeks. About a week into using the cream I finally had non-painful, no bleeding sex again and it was amazing! I had no more problems for about a month.

Then one night I wasn’t lubricated enough and I got another fissure. I was optimistic I could have another sex break and use my cream and it would clear up, however we are now in January and I still haven’t healed. I even waited to have sex another 5 weeks but it was no good. I went back to the doctor, who this time wasn’t so helpful and just said I needed to make sure I use lots of lube and relax and I’ll be fine, and that she couldn’t even see any fissures, however I currently have two.

I’m at breaking point now and this gets me down every day, and I have no idea how to get back to being fully healed again. Lube really isn’t the problem, I just don’t understand how normal gentle sex can damage my vagina every time. Sorry for the length of this message, I really hope you can help me! I have a small diagram below which hopefully makes a bit of sense. I would love to know your opinion, I just need answers! 

Thanks, 
Anon
England, Age 23

Dear Anon,

Thanks for writing, and don’t apologise for a long letter! We love long letters, because we need lots of info. It does indeed seem as though you have a much deeper problem than simply being cut by sex. It also seems as though you are going to need to find someone who can help you discover the root cause, which is likely to be a naturopath or other practitioner, since your doctor seems to have reached her limits of being able to help.

However, let’s theorise for a minute here.

There has to be other signs and symptoms on the rest of your body that will give clues as to why this is happening. For example:

  • Are your periods regular? (which will help tell us if your hormone levels are normal)
  • Do you have skin problems in other areas? (acne, cuts that take a long time to heal, easy bruising, ulcers in your mouth, gum problems)
  • Do you have a balanced and healthy diet? (are you suffering deficiencies of essential minerals and vitamins that work to heal skin?)
  • Have you tried different types of lube? (perhaps you are having an allergic-type irritation response)

These are the sort of questions a naturopath will ask you, because there is something going on in your body that is causing you to tear easily and not heal properly, and there will be other clues – this sort of thing doesn’t happen in isolation. You’re completely correct in being frustrated with your doctor, but doctors really aren’t trained to look for the other causes of these problems. Understanding where your doctor’s interests start and end is really useful, and can save you a lot of time later on.

Delving into the why’s and what for’s and how to fix’s of your body is sometimes more the realm of the other practitioners you will form a relationship with in your life, so welcome! There is a lot you can discover, starting with ‘doctors don’t know everything’.

Money is also probably not in plentiful supply, so here are some ideas for things you can investigate yourself, and see what you can discover before heading to more costly practitioners.

What you’re (not) eating

The first thing I’d be looking at is your diet – is your body getting everything it needs to build and maintain your skin? This can be really hard to answer yourself if you don’t know much about it (when I was 23 I was surviving solely on toast, coffee, box wine and cigarettes – I didn’t know diddly squat).

So we should start simple and get a few things clear. You are 23 and live in a western country, so let’s assume you care about how fat or skinny you are, and adjust your diet in extreme ways, either often, or seldom, and subsist on food with ingredients you don’t understand, with impacts on your body that you don’t understand and are not necessarily totally on top of. I am assuming you don’t know how this works, because most people don’t, especially not at 23.

I would be very surprised if you are eating three square meals a day with a third wholegrains, a third protein, and a third vegetables (as a rough guide), and including regular fermented foods, nuts, seeds, and flaxseed oil. It’s not enough just to not die; we have to make our bodies thrive so they can punch their way through life without becoming too susceptible to whatever is going round. You are showing signs of having become susceptible, but the question is why? 

Your skin needs specific nutrients to be strong, and when you aren’t getting enough of something (or many things) your skin can start to break down, and not heal properly, get ulcers, blisters, sores, rashes, and dermatitis-type responses, and many more problems. It just starts to go funny. This may be what’s happening to you.

Your skin is a good indicator of what is going on in the rest of you, so it’s important to pay attention when you get these little signs that something aint right.

So. Let’s go through the basics.

Protein

You build flesh with protein, so if you aren’t eating enough, you can’t build flesh properly. Take a look at your fingernails – are they ridged? flaky? easily broken or torn? Do you eat meat and eggs every day, and if not, do you know where to get your protein from?

You need to be eating a fist-sized portion of protein at every meal (and that means three meals, or at minimum, three fist-sized portions of protein per day), and if you are vegetarian or vegan, your job is all the harder, because you have to mix up your legumes to get all the amino acids.

You’ll find too that if you are lacking protein, your mental health may be suffering – anxiety, depression, moods – because your neurotransmitters that make you feel good and balanced and ok are made out of proteins (well, actually amino acids, which are the individual pieces of a protein strand).

Zinc

Zinc is one of those little molecules that kicks off a lot of different processes in your body, and if you are missing out on good food in general, you are more than likely missing out on zinc. You need zinc to repair tissue, so if you aren’t getting enough zinc, you can have slow-healing wounds. It’s that simple.

It’s probably not the only thing going on here, but it could be. That’s how powerful zinc is at healing our skin. If you are low in zinc, you may see white spots on your nails, and have an impaired sense of taste and smell.

Fun science fact: Teenage boys are often really low in zinc because semen is high in zinc, so you’ll see the super pimply guy (zinc-skin connection again) who can’t smell very well… That’s from masturbating endlessly and losing all their zinc into a tissue.

Food

These are not the only elements that could be missing, but they are an obvious pair. There are so many elements to healthy skin, and that means eating really well, and not skimping on your food intake. It doesn’t mean shovelling burgers down your face, because that isn’t going to help. You need lots of lean protein (eggs, lentils, chickpeas, tofu (but not too much!), tempeh, and whatever meats you enjoy (not fatty), lots of fresh vegetables, lots of nuts, seeds, healthy oils and fats (avocado, raw nuts, raw seeds, cold-pressed oils).

This is hard for most people to switch to, but if you can get the basics down and avoid eating low-quality food as often as possible (cooking at home usually), then you can see if this makes a difference to your problem.

Supplements could be a way to quickly find this out, with protein shakes and liquid zinc being the best ‘fast’ way to increase your intake without too much effort, until you can get your head around diet changes for experiment’s sake. Get hold of a really good quality (read: expensive, practitioner-quality) vitamin supplement and do a round. See if this lot of changes improves your cuts and tears after a month (you should see a difference in a week or so), and then revisit. If there are no changes, you will probably want to start looking down other avenues.

Hormones

Being low in oestrogen can cause your vaginal and vulvar tissue to not heal very well, and this can be for lots of reasons, but at 23, you would really want to know – immediately – why you would be low in oestrogen, because it is highly abnormal. Lots of menopausal women get this sort of thing, which is called atrophic vaginitis. If you have this, it would mean that something is happening to your ovaries (which produce oestrogen) and that needs to be investigated without delay.

It could be something else

There are a lot of variables with vaginas, and you will need to find someone around who can work with you systematically to figure out what’s happening to you, because it is abnormal. You shouldn’t tear that easily and not heal – both those things are highly suggestive of something happening inside your body or locally on your labia to cause this weakness.

On top of the food and hormone stuff, you could also investigate fungi, and look up lichenoid conditions and see if any of your other symptoms match, and perhaps check out autoimmune conditions like scleroderma for some clues. These symptoms are usually pretty specific, so don’t freak out, but just double check in case there could be suspect symptoms that your doctor hasn’t picked up.

In the meantime

I know it sucks, but avoiding the cause of these cuts and tears – sex – seems appropriate, particularly because when you do have sex, you do it every day. Obviously it’s uncomfortable, but while you figure out what’s happening, you’ll just have to dream up other ways to get each other off! It’s good practice. Sex isn’t the be-all and end-all of things, and while it’s nice and easy, there is other sexy stuff you can get up to. If you do have sex, be super gentle, use lots of silicon lube, and at the first sign of trouble, stop, and give it a break for a few days.

Put together a folder or document with your symptoms and a timeline and keep a journal; things you have tried, things that helped, things that made it worse, and treatments that did nothing, plus all your medical records in chronological order (by date). This includes herbal or nutritional supplements you are on, medications including birth control, and it always pays to put together a diet diary of what you are eating and drinking. This includes snacks, smoking, booze and drugs. It all counts.

We’d love to know what it ends up being,so go forth and experiment! Write back with your progress, and any questions – we’re very happy to help.

Write anytime.

Warmest regards,
Aunt Vadge