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Dear Aunt Vadge,
I’ve had posterior fourchette tears for months. In July I was diagnosed with genital herpes (HSV-1), and it seems to have started there. I cleared that outbreak and a co-occurring yeast infection, but sex stayed painful, with soreness and stinging at the base of my vagina and often a little blood afterwards.
A doctor had me abstain for three weeks; the fissure came back on my first attempt. I abstained another four weeks and was still sore when another yeast infection turned up. They put me on suppressive antifungal and daily suppressive herpes medication, which worked for a few weeks until I tore again. They’re now suggesting oestrogen cream to build up the skin, but I feel too young for vaginal atrophy. I’m on hormonal birth control, we always use lube and go slowly, and I don’t know why I keep tearing in the same spot. I’m 21 and desperate.
Sincerely,
Torn
Age 21, USA
Dear Torn,
This can be sorted out, so let’s start there – recurrent tearing in one spot almost always has a findable cause, and you won’t be stuck like this forever. The tissue at your posterior fourchette (the join at the base of the opening) is fragile right now, and the job is to work out why.
The oestrogen cream idea has merit
You’re right that you’re too young for menopausal atrophy – but that’s not the only way local oestrogen gets low. Hormonal birth control lowers your circulating oestrogen and free testosterone, and in some people that thins and weakens the tissue right at the vaginal entrance, which is a recognised cause of recurrent fourchette fissures and painful sex.
So a trial of topical oestrogen is reasonable, not just a band-aid, and it’s worth asking your doctor about coming off the pill for a few months (with another form of contraception) to see if your tissue recovers. Give any such trial at least a couple of months, since hormones take time to rebalance.
Get the spot properly examined
Recurrent tearing in the same place deserves a proper vulvar examination by a gynaecologist or a vulval clinic, to map the pattern and rule out skin conditions like lichen sclerosus, and to see how much the herpes is contributing. This is the part we can’t do at My Vagina – we’re naturopaths and don’t do internal exams – so it’s worth pushing for that specialist look.
Treating the whole picture
In our clinical experience, tissue that keeps tearing and re-infecting is rarely just a local problem – the whole body (gut, immune resilience, the nutrients skin needs to repair) is usually part of why it won’t settle. Alongside the medical work-up, a naturopath can look at the whole body – diet, gut, immune support, the nutrients your skin needs to repair – to help your tissue become more resilient rather than treating the vagina in isolation.
In the meantime, check whether any lube or condom you use might be irritating you, eat well to give the skin what it needs to heal, and read our guide to vaginal fissures for more on this pattern.
Write back any time.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice.
