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Hi Aunt Vadge,
I’ve had a recurrent posterior fourchette tear for about two years. The first one (very painful) came from sex with a previous partner; the GUM clinic swabbed it for herpes and infection – negative. Six months into my current relationship I had another tear swabbed at my GP for herpes – also negative.
My GP gave me a mild steroid cream and a vaginal lubricant (which I admit I’m not great at remembering to use). The tear has happened several times, and this time I’ve got thrush alongside it.
I also had two slightly white spots either side of the fourchette – painless, and when I pressed one with a swab part of it came off, with no fluid or raw skin underneath. My partner of 18 months has never had spots or ulcers.
Could the fissuring and white spots all be thrush? I’ve stressed myself out reading herpes claims online despite two negative swabs. Where do I go from here?
Yours,
Stressed
Age 24, UK
Dear Stressed,
Let’s close the herpes worry firmly: two negative swabs, both taken on actual tears, means this is not herpes. It doesn’t behave like yours either – herpes is painful, blistering and ulcerating, not painless white spots and recurrent splits. So please stop the internet image-searching; it’s an anxiety machine, and your real test results beat any photo. Let’s put the energy into what this actually is.
The posterior fourchette – that delicate spot at the bottom of the vaginal opening – is the classic place to tear, and recurrent tearing there usually has a small stack of contributors working together.
Yeast is one, and you’ve got it right now: thrush macerates and weakens the skin so it splits easily, and it can leave white plaques, which is very likely what your painless white spots are.
Clearing it properly is step one (see the yeast page), and because it keeps coming back, it’s worth looking at why – recent antibiotics, sugar, gut health.
Friction is the next, and it’s the easy fixable one: the fourchette tears from dry rubbing during sex, so using your lubricant every single time, and being properly aroused first, prevents a real chunk of these. Make it non-negotiable rather than the thing you forget.
Then there’s the possibility of a skin condition.
Two years of recurrent fissuring in the same spot, with whitened areas, is worth having properly examined for lichen sclerosus, which is classic for whitening plus fragile, splitting fourchette skin – and your GP’s steroid cream is actually the right treatment if that’s what it is, which is exactly why it’s worth pinning down at a vulval clinic.
And oestrogen plays in too: if you’re on the contraceptive pill, the lowered oestrogen can thin and weaken the vestibule and fourchette and make them tear-prone, so flag that to your doctor.
So the plan is: clear the thrush, use the lube religiously, and if you’re still fissuring once those two are sorted, push for a vulval-clinic referral to settle the skin-condition question – and swab any future tear while it’s actually there, not after it heals. You’re not back at square one; you’re closing in on it.
Warmest regards,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
