Tearing Posterior Fourchette

[recessivegenequeen]

I am glad you two have found so much useful info to share! I can definitely relate to having to do so much of your own research – it’s insane to me how little so many gynecologists and general practitioners know about pain disorders like vaginismus, vulvodynia, etc. Most of what I learned was online, and I had to be the one to convince professionals that it was going on. It’s a sad state of affairs and I really hope the education gets better so women can get more answers about their options and don’t have to suffer in silence and confusion for years.

[sleeplessinedinburgh]

@recessivegenequeen I totally agree with you, it’s a sad state of affairs, and it pains me to see that this is the one experience we all seem to have in common, no matter where we are in the world.

@Rah, thank you for your words of encouragement. I’m sure it will do me good to get my mind off everything for a while, but please do keep me (and us) updated on how you are getting on with your treatments. You deserve to heal from this too, and you can!

[recessivegenequeen]

Me too Sleeplessinedinburgh, it seems crazy that no matter where in the world you are, and whether there’s publicly accessible healthcare or private healthcare, regardless of the level of freedom or openness, there is so little general education or openness around this topic. At least we have forums like this to communicate, but I hope we see that change in future.

Good luck to you both, and sometimes taking time away is the best thing for it!

[Rah]

Hi Guys just to give you an update.

I’ve had 3 Prp injections 6 weeks apart. I feel it really helped the skin, the only hiccup was I not so wisely had sex, and so I actually tore it a bit. I went on to have the third injection anyways. I feel a bit annoyed at myself that I didn’t protect this phase, but i am human. It wasn’t for that long but it was too soon.

It’s still not completely healed yet but very nearly. I’ve started doing daily perineal massage over the scar for 5 mins with sweet almond oil (as high vit e). This is what was advised by my physio. And then I will start dilators again.

The lady was super lovely and was a cosmetic GP, she actually gave me the 3rd injection half price. So I got 3 injections for $2500 nzd. The first one she injected it into the scar and near the scar on the perineum and also into the glands that help with lubrication (which is the anterior wall). The second 2 I opted for all 7mls to be injected straight into the scar. No bleeding afterwards slightly sensitive but fine. I have to drive 4 hours to get it so able to sit etc.

She suggested then you can have top up ones 6mths to yearly.
I think i am considering having another one. But financial constraints are likely to limit me potentially.

Any of you guys opted for it?

I am doing daily kegels and pelvic release yoga poses.

Happy to hear anything updates from you guys.

I think its helped the skin maybe 30 percent. Maybe more I don’t know yet as just started the stretching. And also i had a fairly fresh tear. However she was of the opinion a fresh tear was fine as it speeds up the healing process.

[mazemelissa]

Hi Rah,

Thank you so much for sharing your experience with PRP injections. I think this is a new field that should be explored. We need more research!

I’d love if anyone else out there has any history with using PRP for either pain, or lichen sclerosis, vestibular fissures. Please share your experience.

Melissa

[Anonymous]

wow

[recessivegenequeen]

Thanks for sharing your experience, Rah! I don’t have experience with your particular issue but love to hear of other techniques that help people so they can get the care they need!

[nina_r]

Hi, ladies.
I have the same issue as Mel1996. I’m 29 and I’ve had tearing posterior fourchette since about 2 years. I started taking contraceptives exactly about 2 years ago and I think that my skin down there started tearing during every sexual intercourse exactly when i started the pill.
I was on the pill up until about 6-8 months ago. After i stopped it nothing changed. The tearing appears every time during sex.
The treatments I’ve tried are the following:
Corticosteroids, laser treatment, vaseline and hyaluronic creams, even surgery(which i think wasn’t done correctly since there was absolutely no change after it)
I’ve been using a local estrogen cream for the past few months(3) since the last doctor told me another surgery is not a good idea as the area is very irritated. I haven’t been using the cream each and every day since i saw that i still get the tearing. The last doctor explained i should use it twice a day for a few months and refrain from sex, but the issue is that me and my partner are trying to have a baby and it’s difficult when I’m having such painful experience. We can only try maximum twice a month which for now wasn’t successful. I’m very very scared that I’ll have this tearing forever since I’ve tried so many things. Please, whoever has had this issue and has healed from it, let me know of any possible solutions. I’m desperate.

[wheat_bag]

Hi Rah, I’m in NZ too, I was wondering where you got your PRP injections and if there’s any updates? I’m dealing with the same issues, it’s happened 5 times this year and I’m getting desperate

[Rah]

Hi Wheat_bag,

I got it done in Hawkes Bay, by Dr Danielle Waxman at Central CosMedic Ltd. Even though I was living in Wellington at the time. I definitely think it helped. But its often a combination of stuff, physio (dilators once its healed) , massage or natural topical moisturisers.

There are a few in Auckland that do it too. I looked at people providing the O shot and then asked if they would inject in into the scar. The good thing about Danielle she was actually a GP before she went into cosmetics.

They are pretty spendy just to let you know! Its about $1000 an injection, and they reccommended 3, 6 weeks apart. You need to find out what might be driving it. Get checked for thrush too.
Managing pelvic floor tension and skin healing is really important, seeing a good dermatologist might be good, although I prefer natural stuff as feel like the medicated stuff never worked for me.
If you’ve never seen a physio I would do that first.

If you are in Wellington Heather Hickey at Habit Health is an excellent physio. As Liz Childs is good.

I might get some it done again here, ive just moved back to the UK.

All the best!!

RAH

[wheat_bag]

Hi RAH,

Thanks so much for getting back to me! My cause is autoimmune, a combination of things I think pelvic tightness from a connective tissue disorder, dryness from Sjogrens, as well as potentially early lichen sclerosis. Not to mention recurrent thrush from the immune suppressant medications. About 5 years ago I saw a pelvic physio and had been dilating and doing exercises and also using topical steroids and things were manageable if I also used a lot of lubrication.

However I went about a year without a sexual relationship and so I let everything except the steroids lapse and when I went back to it earlier this year I wasn’t careful enough and got a tear. I tried to get back to where was by doing an intense course of steroids and starting exercises again but now it seems like the skin is vulnerable and tears along the scar even with a small dilator.

I’m trying to be pragmatic instead of fatalistic though, I’ve booked back into the physio and have found a GP in Te Atatu who does PRP ‘O shots’ for $750. Will ask her at the consultation next week if she will inject into the scar. I’m also going to go back to the dermatologist and ask for calcineurin inhibitors as I think the steroids have stopped working.

Thanks so much for your reply, it’s heartening to know that things can get better.

R

[sleeplessinedinburgh]

Hi @nina_r

So sorry to hear you’re going through this. It can be so despairing when you keep trying possible solutions and seeing no improvement. Been there done that, unfortunately. And I imagine it’s especially frustrating when you’re trying to get pregnant and stop the tearing at the same time.

All the remedies I tried I listed in a previous post on this thread. What worked the most for me was working with the dilators everyday, doing pelvic floor stretches everyday and keeping the skin moisturised. However, it’s very important that you let the skin heal between one ‘penetration’ attempt and the other, whether it’s sex or dilators. Whenever I accidentally experienced tearing again, either because I didn’t use enough lube during sex or tried to push too hard with the dilators, I felt frustrated but I always gave my skin a few days to heal before I touched it again (it usually doesn’t take more than 2-3 days).

You said your doctor also thinks your area there is very irritated, so I wonder if, in your current (very understandable) state of frustration, you’ve been pushing too hard and making the issue worse by irritating the area again and again and not allowing it to heal between tearing episodes.

What if you were to put the pregnancy attempts on hold for a little while, and focus on fixing the tearing problem first? Would that be at all an option for you?
I realise it’s not an ideal solution but it seems to me like you need to focus on healing your body first. Once the pregnancy arrives, your body will inevitably undergo further stress so you want it to be in the best shape possible.

This however are just my 2 cents as someone who has never been pregnant or attempted to be pregnant herself. Maybe there is someone else on her who has dealt with posteriour fourchette fissuring and pregnancy at the same time?

[sleeplessinedinburgh]

Hi @Rah

I was wondering how you’re getting on after the PRP injections. Would you be up for giving us an update?

A little update from me: after I went travelling for a few months I relocated to Switzerland, where I still am currently. For over a year during this time I didn’t do any dilator work or pelvic floor physio of any kind, nor did I have sex. In February this year I started dating someone new, and the first time we tried to have sex the tear reopened again. It’s like during the break I took, the skin lost all the elasticity it had gained through the dilators work. It’s been quite disheartening as it made me realise that this is an issue that will always represent itself, unless I constantly keep up with the treatment.
I’ve been back to the gynaecologist now, who has restarted me on the usual routine of corticosteroid cream, pelvic floor physio and perineal massage. But I hate the thought of having to do this for the rest of my life so I’m on the lookout for a more long term solution.
The gynaecologist has suggested a perineoplasty as a last resort but the results are not guaranteed and I’m hesitant to go for something that will potentially create even more scar tissue down there.
I’m now looking into other potential treatments like laser, PRP and lipofilling (or a combination of these). I’ll mention them to my gynaecologist next time I see her and see what she recommends.

[Rah]

Hi @sleeplessinedinburgh,

I wish I had more exciting news!
I am actually on my second round of prp presently, one to go in the uk.

I also have a private gyane appointment this Monday which I wanted to discuss more the surgical options.

My story is that I haven’t abstained from sex and pretty much to thr year for 3 years I’ve slept with someone and re-opened the scar, which has set me back as I haven’t been able to do dilators. I also have the added complication of hsv2 and a year of thursh infections!

So not been my year this year.

What I would say is be careful with the steroid, it actually thins the skin and you want some inflammatory process! To help it heal up.

I’ve been on a mad healthy eating and supplement question for healing. I found comvita wound gel (manuka honey) helpful. And I am VERY sensitive to products. Also olive bee can be helpful too.

What I would say, is that it’s likely you will need to do dilators but it might get to a point where you only have to do them twice a week for maintence. I think it really depends on what your drivers are too, I.e is it a hypertonic pelvic floor? Is it the skin? Probably a combination of the both.

My tear has now been opening for 12 years so thr skin is pretty f*ck. 5 years of this I just ignored it and didn’t know about vaginismus.

I also saw about lipofilling, and the lazer was offered to me by the person who is doing my PRP. Basically all of them there is no evidence for thr vulva. But prp has been used a long time in treating tendons, so that’s promising.

I can let you know if I find anything new. Because I also feel my skin is the issue atm. What I’ve know been told about zplastys that your tone, or tension needs to be well managed for it to be successful.

The difficult thing is this kind of surgery sits between gynaecology and plastics.
So it’s hard to know who to best consult! I am going to the gyane first.

Have you ever had botox? I seemed to do well with the dilators that year and the skin before I threw caution to the wind and slept with some random person.

I Totally get it and Ive actually felt suicidal at times, but pick myself up and carry on.

I imagine Swiss health care should be pretty progressive?

I imagine if you look after yourself and haven’t torn it too many times, and do all those alternative treatments and the dilators you’ll get there.
Wish it wasn’t the way but if it means having PIV then amazing.

Sorry if this isn’t the reassurance you are looking for.
Maybe across the uk, nz, and Swiss we might find something.
There is a surgeon in Australia I saw online who reports to deal with this. I will put the link up.

Sending hugs!

[Rah]

Hi @sleeplessinedinburgh

I went to the private gyane today, nothing particularly new, but she said it was her experience that low estrogen often is the driver of skin splitting esp. Those who suffer from thrush and hsv.

She felt that low estrogen could drive the flare up of those conditions.
So she prescribed me estrogen pessaries and the cream to put on the scar.
I’ve tried this previously but not recently.

She didn’t know anything about PRP, or alternative treatments really. She did say fentons repair is for a self few only as they can make it worse. But also commented on the fact that it sits between gyane and also plastics.

I personally will consider consulting with a plastic surgery in the future around these things.

She also offered steroids and going back on a combined pill at a later date to stabilise the estrogen. Personally i dont want to do either of those.

Fingers crossed for the local estrogen!

I am even going to start thinking of trying the spiritual root, ever read you are the Placebo by Joe dispenza? You can change your biochemistry, and it seems modern medicine is at its limit in the uk. Esp in the NHS.

R