Tearing Posterior Fourchette

[sleeplessinedinburgh]

Hi @Rah
I’m sorry the meeting with the gyne wasn’t particularly enlightening. It really seems we’re at the stage where we know more than doctors themselves.

I hope you see some improvement with the estrogen. I’ve tried that too at some point (only cream, not pessaries) but didn’t notice any difference. I also did a general hormone screening (blood test) at the time and my estrogen levels were in the norm. But maybe I just didn’t apply the cream for long enough? I was a bit worried about absorbing artificial hormones tbh.

I’ve never heard of that book. What’s it about?
I have thought of trying acupuncture and other alternative medicines. I’ve also considered body-focussed psychotherapy, wondering whether my tense pelvic floor could be linked to unprocessed emotional trauma.

Honestly, there are so many avenues one could explore, but sometimes you just need an answer, right?

I’ve found out that the head surgeon at the gynaecology clinic where I go to here in Switzerland is basically one of the top experts about perineoplasty in the country so I would hope if I decided to go on with the surgery I would at least be in good hands. But I’m still not convinced.
I will talk it over with my gyne again at my next appointment in a month and ask her what she think about the other treatments as well (laser, PRP etc). Maybe I’ll book a consultation with a plastic surgeon here as well.

I will keep you posted. Fingers crossed the cream helps you in the meantime!

[Rah]

Thanks so much for getting back to me, I really would be interested in anything you find out, and that’s amazing to know re the surgeon.

You are the Placebo is basically about the mind body connection. It’s well documented that Placebo affect accounts for 40 percent of improvement in people. Don’t get me wrong I am not saying it is in our head, but apparently there is evidence that if you can get to deep meditative states that you can influence your biochemistry in a positive way, I am a bit off reaching that atm! But I am willing to try it all. Louise hay was talking about it way before Joe Dispenza.

That’s great you are doing therapies too, I also see a hakomi therapist, which is a type of psychotherapy.

I believe there will be an answer. I appreciate all that you share.

R

[Rah]

P. S she suggest 6 weeks of pessaries, first 2 weeks every night and then every other day for the remainder, then topical massage to the scar with estrodiol every night.
Might not be for you, but just letting you know what she reccommended.

[Mel1996]

Good evening. I’ve just been reading through these comments as it’s been many years since I’ve been on this site. After years of gyno appointments, surgery, hormone testing and thinking I had low estrogen I actually managed to fall pregnant last year. Luckily it didn’t take much for me to fall pregnant as I was still experiencing regular tearing during intercourse and it was largely off the table but randomly this one attempt with my long term partner I didn’t tear and I fell pregnant. I had a natural birth with only second degree tears and he was a big baby. So I got very very hopeful that all my problems were solved and my muscles will have stretched etc but this isn’t the case. I am suffering from recurring thrush and I tear spontaneously as well as during intercourse again. I’ve had a biopsy which shows non-specific inflammation – not even sure what that means and have been told to use steroid cream. This is the one treatment I haven’t tried and have been very apprehensive about using.

Does anyone have experience of using steroid cream or has anyone heard any positives about it helping with general inflammation of the skin down there and whether it can help elasticity?

[sleeplessinedinburgh]

Hi @Mel1996
Sorry to hear you’re still struggling too.
I’m currently on a corticosteroid cream called Dermovate prescribed by my gynaecologist but like you, I’ve been hesitant, especially because the doctor told me to use it for a month when on the box it says not to use it for more than 2-3 weeks consecutively. I’ve decided to give it a try just until my next appointment in mid December just in case there is some benefit too it after all.
So far I’ve not seen any effects, either positive or negative, but I will keep you posted.

Have you also looked into Lichen Sclerosus? My doctor says it’s often misdiagnosed as thrush at first.

@Rah thanks for the info too. Did the gynaecologist do any sort of test to determine if there was a lack of estrogen down there or just prescribed the treatment on the off chance? As far as I know there is no such thing as test that can be done, right? I wonder if a generic hormone blood test would pick up on a localised lack of estrogen

[Mel1996]

I’ve been prescribed dermovate and actually after a conversation with a women’s health nurse yesterday during a smear test she’s given me the push to give it a try and she explained the use of steroid treatments really nicely and gave me confidence to try it.

The biopsy would have shown lichen schlerosis if it was that so just getting non-specific inflammation as a result was quite frustrating as it shows there’s a problem with my skin but doesn’t really show what still.

I hope you find the cream starts helping you soon

[sleeplessinedinburgh]

Thank you, I hope the cream works for you too, if you decide to end up trying it.

I don’t know if this is helpful at all but I’m also considering getting a general gut health check, as I’ve heard irritation and other problems down there are often linked to gut problems.
But maybe I’m just clutching at straws at this point…

[Rah]

Hi guys,

I found this article, https://www.sciencedirect.com/science/article/abs/pii/S0301211520308228

Often people with LS have bad skin too and it sounds successful.

Obviously want it to be absolute last resort.

Yes Ive seen a naturopath and also taking probiotics.

I am going to do more research into surgeries.

R xx

[Rah]

Hi Guys

I found this resource recently about how to do more of a fascia release and said this can be helpful in reducing tension in the scar.

https://annacrowle.co.uk/
Some links on that page.

I feel like my PRP is helping and also I am managing the vagifem pessaries which I think are also helping a bit. I still can’t use the cream on the scar.

I also booked a private appointment with Robert Morris who was the plastic surgeon who adviced the gyane Dr Frappell on rhe “Plymouth procedure”. Double z plasty.

So will see what he has to say.

[sleeplessinedinburgh]

Hi Rah,

Actually the doctor who wrote that paper works at my gyneacologist clinic and I have an appointment with him next month.
You can read the full article here: https://www.lichensclerosus.ch/custom/data/ckeditorfiles/Literatur/EuropeanJournalperineoplasty16Dec2020.pdf
It sounds promising but like you, I’m wary of undergoing anything that might cause more scarring down there. I’ll let you know how my appointment goes.

The PF physio I used to see in Edinburgh used to do myofascial release on me, internally and externally, and I always found it helpful. I wouldn’t say it’s enough on its own though, as I still had to do daily stretches and dilator exercises. It certainly didn’t hurt though. I’ll have a look at the website you shared. If you like I can give you the name of my PF physio in Edinburgh, though maybe it’s a bit too far out for you.

Best of luck with your appointment with Dr Morris!

[sleeplessinedinburgh]

Hi @Rah

Oh no, I’m so sorry to hear that you’re still in the struggle 🙁

I’ve been dealing with it for about 12 years too, or at least I think that’s when it all started. Like you, I had the pain but didn’t know what it was and just put up with it. Then I heard of Vaginismus and thought maybe that’s what I have. It wasn’t until a few years ago that I actually realised there was an actual physical injury down there. So I too have been unwisely tearing the skin over and over again. I wish I had been correctly assessed and diagnosed the first time around, so I could treat this thing before it got so much worse.

I can’t comment on the progressiveness of the Swiss healthcare system yet. So far I have been spending an insane amount of money on mandatory health insurance each month and I’ve still had to pay for lots of things (including a smear test) out of my own pocket. I actually have an appointment with my insurance provider today to try and under stand how the whole thing works and what exactly I can hope to get reimbursed. I’m quite certain however that if I had PRP, laser or similar it would not be covered.

I’ve been looking into nutrition as well and other possible underlying conditions. I researched some of my other symptoms and tried to find which nutrient deficiency is linked to all of them. Based on that I’ve started taking iron, zinc and vitamin B. I figured it wouldn’t hurt anyway.
I’m also thinking of doing some other tests, including an HSV test, a hormone test and maybe a gut health test (lots of gut health issues in my family including coeliac disease).

I’ve found someone here in Switzerland who combines laser with PRP: https://www.dr-niggemann.ch/aktuelles/laser-prp-das-dreamteam-fuer-ihre-vaginale-gesundheit/ (article is in German)

Other research papers I’ve found about treatment for vulvar granuloma fissuratum (recurrent fissuring) are based on studies made on people with Lichen Sclerosus (which I don’t believe I have, since I don’t have any of the usual symptoms, but now I wonder if I should get tested for that anyway):

https://www.lichensclerosus.ch/custom/data/ckeditorfiles/Literatur/EuropeanJournalperineoplasty16Dec2020.pdf (This one was actually written by 2 doctors in my current gynae clinic)

https://www.sciencedirect.com/science/article/pii/S2050116116300149

The consensus seems to be that surgery is still the best option, due to lack of sufficient studies on alternative treatments, but I’m still hesitant.

In my case it really seems to be a matter of scar tissue and lack of skin elasticity. Although the PT has found some pelvic floor hypertonicity, this seems to be only mild and more linked to the spontaneous spasm of muscles upon contact, due to fear of tearing. But I’ll see if tests reveal any other underlying condition that I might not have thought of yet.

I’ve also been looking at this vibrator thing that someone wrote about on Reddit: https://thepelvicpeople.com/products/kiwi

There seems to be so much information out there, and yet so little actual, effective help. This thing is incredibly emotionally draining and isolating 🙁
I hope your appointment with the private gynaecologist goes well. If you’d like someone to talk to who understands the struggle, please feel free to drop me a message.

Sending hugs back!

[Rah]

Sorry lots of spelling mistakes in there.

Not that we are going to Aussie

https://drlenkliman.com.au/

I also think on side note how can they do gender reassignment surgery and not be able to create a successful surgery for the perineum?