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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.

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!