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Hi Aunt Vadge,
I’m 54 and menopausal. I have a Mirena coil fitted alongside a Climaval 2mg (oestradiol) pill for HRT, and I’ve used this combination since I was about 46 or 47. My coil is checked every four years.
Recently I’ve been getting tearing and splitting of the vaginal skin, specifically around the top and sides of my clitoral hood and the vaginal opening. These cuts come from the lightest touch – wiping, or arousal – and are extremely painful. I’ve tried emollients and water-based lubricants but they haven’t helped. How can I resolve this?
Sincerely,
Split
Hi there Split,
Skin that splits at the lightest touch is the classic signature of low oestrogen in the vulval tissue – and here’s the key point that catches a lot of women out: you can be on systemic HRT and still have oestrogen-starved skin down there, because that tissue needs oestrogen delivered locally to it. So there are two things to take to your doctor: adding a local vaginal oestrogen on top of what you already take, and ruling out a skin condition like lichen sclerosus, which causes exactly this kind of recurrent splitting in exactly these spots and needs treating in its own right. Emollients and lubricants can only soothe the surface – they can’t rebuild the tissue, which is why they haven’t fixed it.
Why systemic HRT may not be enough for the tissue
Vulval and vaginal tissue is heavily oestrogen-dependent – oestrogen is what keeps it thick, elastic and well-supplied with moisture and collagen. As it drops, the skin thins and loses its stretch, so it cracks at the slightest provocation, which is what you’re feeling. This is genitourinary syndrome of menopause (GSM), the current name for what used to be called vaginal atrophy.
The important part: your Climaval keeps your blood oestrogen up, but the vulvovaginal tissue often needs oestrogen applied directly to it to recover. A low-dose local vaginal oestrogen (a small pessary or cream) works right where you put it, with very little added to your bloodstream, so it generally sits safely alongside your existing HRT. It’s the standard treatment for this exact problem, and it’s well worth asking your doctor specifically about adding one. Our guide to atrophic vaginitis and GSM covers it in more depth.
Rule out lichen sclerosus – this one matters
Recurrent splitting in the same places – the clitoral hood and the vaginal opening – from the lightest touch is also the textbook picture of lichen sclerosus, a treatable skin condition that’s frequently missed or waved away as ‘just dryness’. Lichen planus and other vulval skin conditions can do the same. These need a doctor or dermatologist to look and, sometimes, take a small biopsy to be sure – that’s an in-person job we don’t do ourselves. Please don’t let recurrent same-spot fissures be dismissed without this being excluded, because the treatment is quite different and getting it right protects the tissue long-term.
Strengthening the tissue naturopathically
Alongside sorting the oestrogen delivery, there’s real work you can do to make the tissue more hardy from the inside:
- Plant oestrogens from wholefoods – tempeh, nuts, seeds, soy foods, oats and the like. Get these from real food, not soy supplements; wholefoods work in the body in a synergistic way that isolated supplements don’t.
- Eat well and look after your digestion – you need the nutrients for skin repair and the digestive capacity to actually absorb them. A naturopath who works with post-menopausal women can tailor this properly.
- Move your body – gentle exercise a few times a week keeps the circulation up that feeds the tissue.
- Regular (comfortable) sexual activity, including on your own, helps maintain vaginal tissue function – though that’s one to come back to once the splitting is under control, not while everything is raw.
- Look after your wider wellbeing – staying social, rested and well-fed really supports how your body ages.
Review it with your doctor
Any change to your medication has to be a conversation with your prescriber, because there may also be a second factor in the mix – a low-grade fungal issue or an autoimmune skin condition among them – that a review will pick up. Go in with your two asks ready: a local vaginal oestrogen, and exclusion of lichen sclerosus. If you’d like naturopathic support building the tissue-strengthening side, we’re happy to help – just book in.
This is a solvable problem – you’re not stuck with it. Let us know how you get on.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice. Recurrent splitting of the vulval skin should be assessed in person so conditions like lichen sclerosus aren’t missed.
