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Hello Aunt Vadge,
I’ve had recurrent fissuring of the posterior fourchette for four years, after every sex session. Can constant fissuring lead to lichen sclerosus, since I keep tearing the skin? I had pain at first, but now there’s a tiny fissure that just doesn’t heal and sits at the bottom of my vagina.
No pain or itching now, but I’m afraid I could trigger some autoimmune reaction from the constant reopening. It’s like a paper cut. I’m married, I’ve seen my gynaecologist and done all the tests – no thrush, no BV, no itching, normal hormones, regular smears, all clear.
I use virgin coconut oil as lube and it helps. The thing is, my husband is well endowed (about 15 cm girth). Could a thick penis be causing the fissuring? With a previous, smaller partner I didn’t have this problem.
Thank you,
Concerned
Age 31, Europe
Dear Concerned,
Let’s settle your biggest fear first: no, this isn’t going to give you lichen sclerosus. Lichen sclerosus is an autoimmune skin condition that arises on its own – it isn’t ‘provoked’ into existence by friction or by a repeatedly grazed spot, so the constant reopening, while uncomfortable, isn’t seeding an autoimmune disease.
You’ve also had a thorough work-up – no thrush, no BV, normal hormones, normal smears – which is reassuring and rules out the usual hidden drivers. So you can put the autoimmune worry down.
And yes, your reasoning about your husband is almost certainly right: a notably wide penis can be the whole cause of recurrent posterior-fourchette fissuring, especially when a smaller previous partner never caused it.
We like to imagine the vagina accommodates anything, but a genuine size mismatch is a real and common problem, and that delicate spot at the bottom of the opening is where the extra stretch concentrates and splits.
The reason it’s now a fissure that ‘just sits there’ and won’t heal is that it never gets long enough to close before the next session reopens it – so the single most important step is to give it a proper, uninterrupted break: no penetration for two to three weeks so the skin can fully heal for once, rather than half-healing on repeat.
Then it’s about preventing the split rather than just patching it.
Keep using plenty of your coconut oil (or a generous lube), make sure you’re fully aroused and relaxed before penetration so the tissue is at its most supple, and work with positions that let you control the depth and angle and keep pressure off that back wall – woman-on-top is often the gentlest.
Gentle perineal stretching/massage between sessions can build a little more give in the tissue over time, and because this is a mechanical mismatch rather than an infection or a skin disease, a pelvic-floor physiotherapist – or a clinician who works with couples on exactly this kind of problem – is well worth seeing, as they can tailor the approach so you’re not stuck choosing between sex and a permanently broken spot.
The key message: it’s friction from a size mismatch, not autoimmune doom, and it’s very workable once the fissure finally gets to heal and you change how penetration happens.
For soothing and healing minor cuts and tears, here’s how to deal with cuts and tears from fingering and rough sex.
Warmest regards,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
