Aunt Vadge: small dot on posterior fourchette that won’t go away

Hello Aunt Vadge,

Thanks for listening. 

I have had a “something” on my posterior fourchette for a very long time – always in the same place, always just the one.  A single dot, but when the dot is pressed, there is soreness. I’ve had this since menopause, therefore for fifteen years. It seems like a sore dot on the little tiny flap of the fourchette. I’ve tried to see it, but I couldn’t really see it, as too awkward. It is usually only sore if it is touched.

Often, it is sore even if it is touched lightly (by me). I would love to not have this thing, whatever it is, because of the soreness. Needless to say it makes sex or masturbation painful. I have been avoiding having sex for a very long time because of this.

I would like to begin a relationship, so would love to get rid of whatever it is and at least get rid of the soreness.  I was referred by my GP to a National Health Service Gynaecologist some years ago, but all he did was recommend HRT. I am not interested in HRT. I would grateful for any advice. Thank you very much. 

All the best,
Age: 67
Country: London, United Kingdom

Hi there Dotty,

Because the spot appeared when you hit menopause, treating the spot with hormones seems like a logical first step to see if it gets rid of it. If it doesn’t go away, then it would need further investigation, but if it clears it up, then you know that low oestrogen was the culprit. There are many ways to address this once you know if the spot is due to low oestrogen, but the experiment is a useful one as a method of exclusion. But, this does NOT mean you have to do HT.

Hormone replacement therapy (HRT, now called just hormone therapy, HT) is the administration of hormones by mouth or patch, or another delivery method, into your bloodstream. This increases circulating hormones, and acts similarly to your natural hormones, boosting both synthetic oestrogen and progesterone.

Once you hit menopause, however, hormone therapy is based on need. I’m not sure how long ago you visited your gynaecologist, but it would be unusual for a woman who is 15 years past menopause to be put on hormone therapy in this way. I

nstead, it is more likely that an oestrogen cream would be prescribed, which you apply to your vagina and vulva a few times per week (or as per the instructions). The safest form of oestrogen for women past menopause is E3 (oestriol), as it is not absorbed into the bloodstream and does not cause cancer.

Read more about using E3 for atrophic vaginitis (now known as genitourinary symptoms of menopause, GSM).

You may also notice other changes to your vulva and vagina due to low oestrogen. It could be dry, with the skin breaking easily, and if you do get a cut, it can take a long time to heal. This may be what the spot is – a little bit of damage that can’t heal properly.

It seems like a useful experiment to see if the oestrogen cream clears this up, so my recommendation is to go to your doctor and ask for a prescription for a vaginal E3 oestrogen cream. Use it for a few weeks as directed, and see if it makes a change in your symptoms.

If it does, then having the cream handy is a good idea for the future (you don’t have to use it all the time), but then you can start adding in some plant phytoestrogens using whole food sources (tofu, soy milk from whole beans) to naturally increase your oestrogen levels.

Using plant oestrogens is a good thing to discuss with a naturopath or herbalist. If you definitely do not want to use a cream even just for an experiment, then I would suggest going to visit a hormone/women’s health specialist naturopath or herbalist who can use herbal medicines and herbal creams for the same effect, but in a way that is personalised for you.

Plant sources of phytoestrogens are 300 times weaker than human oestrogen, but they fit the same receptors, so have a weak effect. This weak effect can be just enough to keep this sort of vaginal problem at bay, and help keep your skin stronger and more functional. Women’s bodies are full of oestrogen receptors, and when we’re fertile, this keeps our vaginas juicy and healthy.

The other scientifically proven method of keeping your vaginal cells healthy and functional is regular sex or masturbating, though obviously this is difficult with your sore little dot. But, once you get rid of it, keeping sexually active regularly can do wonders for your vaginal cells, including the tissue of the posterior fourchette, which is part of your vulva (and full of oestrogen receptors). Keep this in mind!

If your spot still stays put, without changing, even after a few weeks of oestrogen cream, then you know that something else is going on. In that case, I would suggest going back to your gynaecologist and asking for further investigations. There are further options as to what it could be, but it’s a process of elimination, and so starting with the easiest first seems logical!

Warmest regards,
Aunt Vadge