Aunt Vadge: posterior fourchette tearing after sex – why is this happening?

Dear Aunt Vadge, 

I have been having issues with posterior fourchette tears for months. In July I was diagnosed with genital herpes 1 and it seems like that’s where it started. I took medicine and cleared up the outbreak as well as a co-occurring yeast infection and was fine. But sex was painful and I was also sore or stinging at the base of my vagina and there was often a little blood on the toilet paper. 

A doctor had me abstain for three weeks until I was healed, but the fissure recurred on my first sex attempt. I abstained for another four weeks and was still experiencing pain when another yeast infection was discovered. They put me on both suppressive yeast and daily suppressive herpes meds to battle the fissure. It worked for several weeks until I randomly got another fissure.

They are now talking about estrogen cream to build up the skin down there. I feel I am too young to have vaginal atrophy. I abstained for another almost two weeks and was still sore and tore again a bit on my latest sex attempt. I am desperate for an answer or cure. I worry I won’t be able to experience sex without pain again and will only be able to have sex once every few weeks to recover from the last. I am on hormonal birth control but my partner and I always use lube and try to start slowly. I don’t know why I keep tearing in the same spot.

Please help! 

Age: 21
Country/Area: USA

Dear Torn,

It sounds like you are in a bit of a pickle. Your vaginal and vulvar tissue seems to be very fragile.

I think we can safely say that you will once again have sex whenever you want without pain – this problem will get dealt with, and your body will go back to normal. When you are having an immune system ‘event’ like a virus and fungal infection, your body takes some time to heal, and while it can feel like this is going on forever, once the true cause has been established and eliminated or managed, your body will return to baseline. This can be achieved – don’t worry!

You are too young to have vaginal atrophy, but this isn’t what you have so don’t worry about that. Oestrogen cream may or may not help, but the true cause needs to be found, not just a band-aid of oestrogen cream. Why is your tissue so fragile? That’s the real question. I’m sure you have been lectured extensively about being properly lubricated during sex and all of that, but generally you know your own body and we’ll just assume it’s not because you’re doing it wrong.

There seems to be more going on with your body than we are able to deal with effectively from across the internet, since your immune system seems to be involved. Your recurrent yeast infections are a sign of yeast overgrowth in your gut; it’s almost never just a vagina thing. That, plus your herpes outbreak, will have placed a burden on your system that needs to be bumped back to normal.

I know you are 21 and may not have the funds, but you would be very well served to see a naturopath to have your whole body treated, not just your vagina. Your tearing isn’t necessarily a vagina problem, per se, but a whole-body issue that is manifesting in your vaginal tissues. There will be a whole bunch of other signs and symptoms that your doctors are not looking for to indicate what else might be going on. I am not sure you are going to get much help from your doctor, because they just don’t really have the tools to solve mysterious vagina problems like this. They will keep throwing different items at your vagina.

Your naturopath will do a thorough examination of your life – food, feelings, body, etc. – and can offer you insights into the true cause of this based on their observations. Your fissures need a bit more of a hands-on approach than I can do from here I’m afraid.

In the meantime, check any products you are using (lube, condoms) that could be the culprit, make sure you are eating really well (skin needs nutrients to be strong), and you could potentially think about going off your birth control for a test period to see if it made any difference to your condition. There is no real known link between birth control and vaginal fissures, but that doesn’t mean there isn’t one in your case. Artificial hormones can work in mysterious ways, and it’s worth doing an experiment. You’ll need to use another form of birth control to have sex to test the theory, and it may take many weeks for your body to return to normal hormone levels, so give it four at minimum. You will know if it’s working after a few weeks.

Feel free to write back anytime.

Warmest regards,
Aunt Vadge  

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