Something else? Ask Aunt Vadge – bottom left of your screen!
Dear Aunt Vadge,
Can’t have sex because my vulva tears in one spot. I use BHRT oestrogen cream three times a week in the vagina. Nothing helps.
Yours,
Split
Age 73, USA
Dear Split,
A vulva that tears in the same single spot every time despite vaginal oestrogen three times a week points to something beyond simple low oestrogen – because if low oestrogen alone were the whole story, the cream would be helping more than it is.
The most likely culprit, and the one most worth ruling in or out, is lichen sclerosus, a common vulval skin condition in women past menopause that makes the tissue thin, white, fragile and prone to splitting in exactly one favourite spot (often the posterior fourchette or near the clitoral hood).
It’s frequently mistaken for “just dryness” for years, and it responds very well to a prescribed steroid ointment once it’s diagnosed – so getting a proper vulval examination is the single most useful thing you can do.
In the meantime, a few things really do help fragile, low-oestrogen tissue: keep up the vaginal oestrogen (and ask your doctor whether the dose or frequency could be increased, since some women need more), use a generous amount of a good lubricant for any sex and reapply it, and protect the skin with plain-water washing and a bland barrier ointment.
But please do get that spot looked at by a gynaecologist or vulval clinic – a fixed, splitting spot that doesn’t respond to oestrogen deserves a proper diagnosis rather than more guessing, because if it is lichen sclerosus the right treatment changes everything, and any persistent single area is worth checking simply to be thorough.
Warmest regards,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
