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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,
It sounds like you’re in a bit of a pickle – your vaginal and vulvar tissue seems to be very fragile right now. I think we can safely say you’ll have sex whenever you want without pain again; this will get dealt with and your body will return to normal once the true cause is found. So don’t lose heart.
Look for the root cause, not a band-aid
You’re too young for the kind of vaginal atrophy they mean, and that isn’t what this is, so don’t worry about that. Oestrogen cream may or may not help, but the true cause needs to be found, not just papered over with a band-aid of oestrogen cream. Why is your tissue so fragile? That’s the real question.
Your immune system seems to be involved here. Recurrent yeast infections are a sign of yeast overgrowth in your gut – it’s almost never just a vagina thing – and that, on top of a herpes flare, has put a real load on your system. Your tearing isn’t necessarily a vagina problem in itself, but a whole-body issue showing up in your vaginal tissue.
For that reason, you’d be very well served to see a naturopath to have your whole body treated, not just your vagina. A naturopath will look at the whole picture – food, feelings, body – and work out what’s really driving this, rather than throwing one treatment after another at the vaginal tissue and hoping.
Another perspective worth having in the mix
To round it out, there’s a recognised link between the combined pill and fragile tissue at the vaginal opening: hormonal birth control can lower your oestrogen and free testosterone and thin the vestibular tissue, which is one documented cause of recurrent fourchette fissures and painful sex. So the oestrogen-cream suggestion isn’t coming from nowhere, and trialling a few months off the pill (with another form of contraception) is a reasonable experiment – give it at least four weeks, since hormones take time to rebalance.
It’s also sensible to have the spot itself examined by a gynaecologist or vulval clinic, to map the pattern and rule out a skin condition such as lichen sclerosus – that’s the physical-exam piece we don’t do at My Vagina.
In the meantime
Check whether any lube or condom you use might be irritating you, eat really well to give your skin the nutrients it needs to be strong, and read our guide to vaginal fissures for more on this pattern. In our clinical experience, fragile, slow-healing tissue like this settles best when the whole body is treated, not just the vaginal symptoms.
Write back any time.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice.
