Tearing with sex at age 49

[Momma Bear]

For the last two years, I’ve torn in the same area almost every time I’ve had sex with my partner. It appears to be a posterior fourchette fissure. The first time I tore, I heard something pop. We reconnected after several years apart. My partner’s girth is very thick. Two years prior to reconnecting, I was celibate and noticed I’d sometimes feel raw in my genital area. I have endometriosis and have been on birth control pills for years to manage the pain. I’m certain I’m perimenopausal but my gyno wants me to continue birth control for a few more years. Previously I was on combo pills but changed to progesterone only pills after noticing migraines increased. My primary doctor prescribed estradiol cream intravaginally but it was so incredibly messy and I felt I had to plan my sex life when I could take a break from it so I stopped using it. Also it didn’t seem to help where I tore on the outside. I use a non-prescription hyaluronic gel that I buy online for maintenance but even it doesn’t help every time. We use coconut oil as a lubricant. Currently I’m in so much pain. It’s been 3 days now and it still burns when I urinate. Exercise aggravates it as well. It will heal but I want to prevent this in the future. I’ve discussed with my gyno but she has no idea what it is. She’s asked for me to come in when it happens for an exam but it’s very inconvenient to drive so far, wait so long, and need to urinate while there.
I’m currently using a peri bottle when I urinate but it still hurts so bad. I’ve gathered from reading other posts that options include Botox, surgery, dilators, using coconut oil or estradiol cream daily (topically), and massage. I’ll speak to my gyno about Botox and surgery and begin the other options immediately. Are there any other things I can try? Healing is my focus at the moment.

[mazemelissa]

Hi Momma bear,

I’m so sorry to hear about your pain!

I think that your gyn giving you the estradiol cream was on the right track, as being on the pills for so many years will make the tissue at the vaginal entrance more sensitive to tearing and the lack of hormones is usually the culprit. When i give the topical estrogen (or usually I give a compounded estrogen/testosterone cream) i always direct my patients to rub the cream directly into the posterior fourchette and massage it into the area until the cream is absorbed. This helps with the mess factor and also helps to treat the problem area directly. Many of my patients are advised to insert the estradiol cream with the applicator deep into the vagina, but that doesn’t really help as much as just rubbing the cream right into the vaginal opening, and then you have the drip factor, which you avoid if you just rub the cream in.

You might also really benefit from dilation therapy to slowly stretch the vaginal entrance to help prevent tearing.

Botox would help with muscle tension, but won’t help heal the tissue if it is impacted by lack of hormones.

Hope this helps. Melissa

[Momma Bear]

Thank you, Melissa. This is helpful!