Something else? Ask Aunt Vadge – bottom left of your screen!
Hello Aunt Vadge,
I’ve had a ‘something’ on my posterior fourchette for a very long time – always the same single dot, in the same place, sore when pressed (sometimes even with the lightest touch). It started at menopause, about fifteen years ago. I can’t really see it, but it sits on the little flap of the fourchette.
It makes sex or masturbation painful, and I’ve avoided sex for a long time because of it. I’d love to start a relationship and get rid of the soreness. My GP referred me to an NHS gynaecologist years ago, but all he did was recommend HRT, which I’m not interested in.
Any advice?
All the best,
Dotty
Age 67, London, UK
Dear Dotty,
Fifteen years of giving up something you’d like to have – let’s see if we can change that. Two things matter here: a likely cause you can test cheaply, and a proper look you’ve never actually been given.
Because it started exactly at menopause, low oestrogen is the prime suspect. As oestrogen falls, the vulval and vaginal tissue – the fourchette very much included, since it’s packed with oestrogen receptors – becomes thin, dry and fragile, so a tiny spot of damage simply can’t heal and stays sore for years.
That fits your single, fixed, persistent dot beautifully. And here’s the distinction your gynaecologist never made clear: a local oestriol (E3) cream is not the same as HRT.
HRT puts hormones into your bloodstream; a vaginal E3 cream, dabbed on a few times a week, works only on the local tissue – it isn’t meaningfully absorbed into your blood and doesn’t carry the systemic risks you’re rightly cautious about.
So you can decline HRT and still try this, and it’s the perfect low-risk experiment: a few weeks of E3 cream, and if the dot settles, you’ve found your answer (genitourinary syndrome of menopause).
What I really want for you, though, is a proper look – because it sounds as though nobody has actually examined the dot; you were handed an HRT suggestion instead. A single, fixed spot that’s been there fifteen years and never healed deserves a proper vulval examination, ideally at a vulval clinic.
Most likely it’s the fragile menopausal skin or a small benign thing – a cyst, an old fissure, a skin change like lichen sclerosus – but any persistent, non-healing spot in this area is worth a clinician’s eyes to be sure, not to frighten you.
So do both: try the cream and ask to have it looked at.
If the cream helps, you won’t need it constantly – keep it on hand, and support the tissue naturally too. Dietary phyto-oestrogens (whole soy, tofu, soy milk) fit the same receptors weakly but helpfully, and once the dot is sorted, regular gentle sex or masturbation is well-evidenced help for keeping menopausal vulval tissue supple and resilient.
If you’d rather avoid the cream altogether and take a herbal route, you can book with one of our naturopaths for a personalised plan. You’re not stuck with this – test the easy cause, get those trusted eyes on it, and there’s every chance you’ll have that relationship you’re after.
Warmest regards,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
