Tearing Posterior Fourchette

[taylorp]

Hi there. I’ve come across this forum recently and like some advice. I’m dealing with similar issues as the people above are. Constant tearing/cutting of the posterior fourchette whenever me and my bf try to have sex.
I’ve done the dilators before, as I needed the stretch out the area before we were able to successfully do anything. After a few successful tries, I stopped using the dilators. And now it’s been many months of issues. I can no longer do them like I did before.
I am on the pill, however I am on a combined pill, so it has estrogen and desogesrel. Because of medical family history, my doctor doesnt want me on any more estrogen, however she has prescribed to me a low dose estradiol vaginal insert. Do you think this will help the issue?

[Rah]

Hi
I have similar issues with tearing. I have been on the pill for 10 years and have come off 6 months ago. I also have vaginismus which I have been combating for 10 years.
I am currently in New Zealand. The renevee do you know what other active ingredients are in it? I am not sure I can get it in new Zealand but I am desperate to try something. I even have tearing with dilators and I can’t even feel it at the time. I have been with my partner five years and it’s on the brink of collapse. I am trying to do everything I can do. I have had PT, gynae and they all say the tesr is small but it hurts! And it keeps happening. I feel my muscle tension is improving and I feel I could insert the largest dilator but it will still tear. I feel the tear is stopping me progress more than the vaginismus. Please help!

[sleeplessinedinburgh]

Hi, I’ve been reading some of your posts over the past year or so as I have been trying to find solutions to the same issue, which I’ve been experiencing for many years. After doing some research online, I came across this information paper by Dr Nunns, based in Nottingham (UK).
⚠️ Warning: it contains graphic images of vulval surgery. I hope it’s okay to share this here.
https://bssvd.org/wp-content/uploads/2019/05/Double-opposing-Zplasty-with-VY-advancement-a-treatment-for-posterior-fourchette-fissuring-vs-1.pdf

The paper described exactly the symptoms I’ve been experiencing so I decided to track down this doctor and book a consultation with him. He diagnosed me with recurrent posterior fourchette fissuring and recommended me for surgery to remove the scar tissue which is recurrently getting torn when I have sex or have an internal examination. However, the waiting list to do it under the National Healthcare Systems was more than a year long, so I decided to think about it and try some of the things he lists as the ‘Conservative treatments’ in the meantime. I tested for local infections and STDs. All came back negative. I also did a private at-home hormone test and a thyroid test. All normal there too.

I then started seeing a Pelvic Floor physiotherapist who diagnosed me with an hypertonic pelvic floor and gave me exercises to do to address that, as well as giving me regular myophascial release treatment to get the PF muscles to relax and stretch.
Alongside that I purchased a basic set of dilators and used them for 5 minutes every morning, starting from the smallest one to the largest. When I was comfortable using the largest one without tearing, I actually purchased a dildo online and started using that instead, as it seems like the most logical step up. It’s the closest to the real thing and when I got to the point where I was able to insert it comfortably without tearing (it took a few weeks of regular training!), that’s when I felt confident enough to attempt actual intercourse, and it all went well – I was able to have sex and stay pain and tear free! I was also able to have a smear test without tearing, which was great, as that had also been an issue.

Unfortunately the problem is still not fully fixed as I have experienced tearing in the same spot again a couple of times over the last few weeks, after I stopped using the dildo regularly and doing the exercises that my physio gave me. I got too comfortable, I guess, but it is frustrating to think that I have to continue doing the exercises regularly or the results will reverse. So I’ve had to go back to the dilators and build up slowly again till I was comfortable with the dildo again. It doesn’t help that I’m not in a relationship and I don’t have sex regularly, meaning I don’t really get a chance to see if everything is still okay, unless I try using the dildo. And I hate the thought of having the chance to be intimate with someone and getting anxious because I don’t know if I’m still okay down there or not.

I have now been able to get my GP to prescribe me an estriol cream, which I will try to use every day for a while. This will hopefully clarify whether the initial tearing came from a local lack of estrogen, which is the only other conservative metho/potential cause on the list that I haven’t tested yet.
Hopefully it will be the final piece of the puzzle. But I will also continue to use the dilators/dildo and seeing my physio once or twice a year. If I get tired of that, I will consider doing the surgery. I wish I didn’t have to, to be honest, but it’s good to know the option is there.

This is my journey so far. I wanted to share it here because I’ve found reading some of your posts helpful in my research and maybe my experiences can help someone else. At least in knowing you’re not alone in this!

[recessivegenequeen]

SleeplessInEdinburgh, thank you SO much for sharing your experiences in detail, as well as what worked and what didn’t! As you can see from how many posts are in this thread, this is a frequent issue that comes up and I have never known anything to recommend, so this is hugely helpful. I am so glad to hear that you have found treatment options that have been effective for you. It’s super frustrating that you have seen regression when taking time off from the stretches, but hopefully that won’t always be true. I had vaginismus and it was also important to keep up a very regular routine, which could be annoying and tedious for sure. If you find yourself in a relationship and having intercourse regularly, that might also be enough to keep your body prepped so that the tearing isn’t happening regularly. I’m wishing you the best of luck, and thanks so much again for sharing all this useful information with everyone here!

[Rah]

Thank you so much for your reply! It’s really helpful so see what has worked.
I’ve actually just had a prp (plasma rich protein) injection into my scar on my posterior fourchette and anterior wall, as a first of a series. Not lots of evidence for it but can be helpful with inflammation and its used alot in tendon rehab in orthopaedics. Sometimes called the O shot in more cosmetic clinics. Fingers crossed its helpful and then i plan to start my dilators stretching routine again!

[sleeplessinedinburgh]

Hi Rah, thank you for sharing.
I have heard of something similar before, while I was doing my research. Is this something you’ve had to pay for privately or were you able to get it prescribed by your doctor? I can see from a previous post that you’re based in New Zealand, so I imagine things might be different over there than they are here where I am, in the UK.
In any case, I hope you get some benefit from it and you’re able to resume a comfortable life soon. I know how emotionally deteriorating it can be, trying to find a solution for this problem, especially when there doesn’t seem to be a lot of help out there (and whatever help there is seems so incredibly out of reach!)

[recessivegenequeen]

Great to hear this, Rah – please do let us know how it ends up working for you! It’s great to hear all these different treatment options that are available, I didn’t know about so many of them!

[Rah]

Hi guys,

Yes I paid for it privately in new zealand which was $1000 for one injection. I am actually originally from the UK and I am going back for a few months so have been looking it up there. It is cheaper in the uk around £300 to £400 per injection but i have also seen it for about £200 if you book several. They say around 3 injections is best. I doubt anyone would do it on the NHS! But let me know if you find it.
I also was reading there is an element of the effectiveness is how good the person doing it is. Like even centrafuging the blood and then also the accuracy of the injection. Also they then say a yearly injection is helpful to maintain.
At this point I want to try everything to avoid surgery.
My gyanecology here advised I could have a Fentons procedure but i have looked that up and seems a bit 50 50 if it iwll work but I haven’t looked at the evidence recently.
It’s great you have had pain free sex! Even if it was short lived, or you are having to go back to your exercises. It means it is possible!
I’ve also read about hyaluronic acid injections too but that was a random paper in Eastern Europe somewhere. I haven’t seen any practitioners offering it.

[Rah]

I’ve also had botox, which I found very helpfil for muscle tension! Unfortunately though I had already developed a prolapse a few months before so I felt I didn’t get the best benefit from it but I did get to a biggish dilator!
I wish I had botox before I had all the tears starting and my prolapse last year.
Botox you can have on the NHS otherwise its about £2500.
I basically spend all my money on my health atm. And odnt have any longer savings as it goes all into that! I paid for my botox here privately with was $6000.
But health is priceless right!

[sleeplessinedinburgh]

Hi Rah,
Thanks for sharing. It’s always good to hear what other people are trying (although it sucks to have to do this in the first place!)
I agree, I highly doubt the NHS would pay for this. It took me over a year just to get an appointment with a gynaecologist through the NHS, and it was an utter waste of time as he had clearly no understanding of what I had, nor any interest in helping me. He also suggested Fenton’s but, like you, I was aware of the low success rate of this procedure (through my own research, not even the gyno’s advice!) so I pushed back against that and decided to keep trying things on my own.
The procedure that the private Gyno I saw in Nottingham suggested is slightly different to Fenton’s, and as he explained it is often used in cases where Fenton’s wasn’t successful. This procedures has a success rate of about 70%, which also isn’t great, if you ask me. Especially if you choose to pay for it privately, which would cost you about £3000, on top of any additional consultation fees.
Agreed, health isn’t cheap, but it’s also not fair that one should spend all their savings on it. Considering how debilitating this condition is, treatment should be accessible to all, not a privilege of the few 🙁

[Rah]

70 percent sounds better than 50! I will let you know how the prp goes. I think i am going to have another one in 6 weeks as that’s the recommended.
Today I looked i feel like my scar and skin looks healthier.but that also could just be i am in a different part of my cycle.
Yeah it’s sad because lots of people might not have this available to even be able to pay. I mean i do sacrifice things to make it happen but I do have a reasonably paid job.
I might consider a consult with the Nottingham surgeon when I am back.
Do you mind me asking where you are based sleeplessinendinburgh?

Appreciate anyone putting their ideas up here!
X

[sleeplessinedinburgh]

Hi Rah,
I’m based in Edinburgh, Scotland. So it was also a considerable expense going to see that specialist in Nottingham (travel, on top of already high consultation fees). I still think it was worth it though, even if only to have someone who actually understands something about this issue confirm that this is in fact what I’m suffering from. Most other doctors I’d seen didn’t even grasp what I was trying to describe to them.
Like you, I was privileged to be able to afford the expense at the time, but there are many other women who wouldn’t, which is sad.
I do hope the prp injections work out for you, and you start seeing progress soon. And yes, please do keep us updated on how you’re getting on. I’ll be rooting for you!
Do you mind me asking how you came across the injections as a potential treatment? Were they recommended to you by someone?

[Rah]

Hi SleeplessinEdinburgh,

Your name should have been the give away!
I am rooting for you too! I might also try and arrange a consult with him, i am originally from Bristol area so a bit of a trek.

I wasn’t recommended no, I just did lots of googling. I am actually a physiotherapist so I have heard it being used for tendons, but not scars. To be honest, I had to even do my own research for botox, and originally no one referred me to physio. I referred myself when I realised that they could help me.
So actually all the treatment I’ve had has come from me researching. Bar my very first gynaecologist review I had 10 years ago, they just gave me dilators and a CD. And that was it. And steroid cream which is bad long term.
So yeah been a rough ride.
I refer lots of my clients to pelvic health now! Just wished I had someone looking out for me those years ago.
Hey ho it is what it is.
Dr Bri vibrant pelvic health is a very good online resources. And also there is a girl on instagram who has a similar issue to us, i think she is called queen of eves but she is much like us and not sure what her diagnosis is.

[sleeplessinedinburgh]

Thank you for sharing those resources, Rah!

I’m the same, almost all the knowledge I have about the issue and the treatments I’ve tried have come from my own research. GPs only suggested steroid cream, like in your case, and the NHS gyno I went to see a few months ago (after being on the waiting list for over a year) literally just said to me “Well, I guess you’ve tried everything so I don’t know what to tell you” (!). I eventually got him to give me a prescription for oestrogen cream, but only after I’d suggested that lack of oestrogen might have something to do with it (again, as I’d found out through my own research). That was the only treatment I hadn’t been able to try on my own, due to needing a prescription for the cream.

Frustratingly, I haven’t been in a stable relationship (and having regular intercourse) for a few years now, so the only way to know if any of these treatments are really helping is to keep using the dilators every other day and I’m running out of energy to keep up with it. This might sound weird (and hope it’s not oversharing!) but I’m starting to mentally associate penetration with the dilator exercises, rather than sex, and I’m afraid when I’ll get the chance to be with someone intimately again, I will be put off by it.

In a couple of weeks I’ll be going travelling for a few months to North America and I’ve decided I’m just going to forget all about this issue until I come back. It’s quite possible I might get tearing again the next time I try to have intercourse or a smear test, but I’ll cross that bridge when I get there. For now I just need a break from worrying about it, as it can be really draining, especially going through this whole journey alone, as I’m sure you know too.

[Rah]

Hi Sleeplessinendburgh,

Lots of GP suck at women’s health and even the gyanecologists lack good knowledge!
I totally get it, it’s really hard to keep up the energy with it all. I think that’s a great idea about just enjoying yourself, that is also part of healing too, forgetting can be important.
I am also not in a relationship, so it’s also challenging. I would say from all my research and personal experience that using the dilators or the dildo in a fun way too! Not just clinical medical and that can really help.
I totally get it about being anxious about telling someone new or trying to get the translation from dilators to sex. Remember sex is actually a mind game! So reducing anxiety in any shape or form is important.

You got this girl! Go enjoy yourself on your travels, you deserve it!