October 15, 2024 | Jacob Komarow

What are posterior fourchette fissures and how can you treat them?

Due to the complexity of the human body and each of its organs, there are many possibilities for things to ‘go wrong’. This may happen because of injury, toxicity, dysfunction stemming from other influences… the list is long! This certainly applies to the vagina. It comprises so many delicate parts and even has its own mini ecosystem, which can be upset by the smallest of lifestyle changes.

Getting to know the different parts of the vagina isn’t something most of us bother with until something goes wrong – which may be why you have only just heard of the posterior fourchette! It may also have come as a surprise to learn that you can develop fissures of the posterior fourchette – but if this is a problem you’re dealing with, you’ll no doubt want to learn why you have these fissures and how you can treat them. Our article aims to help you with exactly that…

What are fissures of the posterior fourchette?

The posterior fourchette is the thin, V-shaped piece of skin that connects the labia minora at the bottom. It sits just above the perineum. This little piece of skin is supposed to be stretchy, but in some females it isn’t as stretchy as it needs to be. A fissure, by definition, is a split or tear in the skin. You may have heard of or experienced anal fissures, which are more common – these are tears in the mucosa (moist tissue) near the anus.

Posterior fourchette fissures happen because the skin doesn’t have the elasticity that it should. The skin splits when it isn’t able to stretch the way it needs to, often causing intensely sharp stinging pains. Fissures can be very painful and difficult to heal, especially if they keep recurring. Recurrent fissuring of the posterior fourchette (termed vulvar granuloma fissuratum) can cause severe pain.

What are the symptoms of posterior fourchette fissures?

The most common symptoms are tenderness and inflammation of the tissue (and surrounding tissues), as well as burning, itching and stinging sensations – especially on contact with liquids such as urine, semen or even water. Bleeding is common, and there may be swelling and lumps present. Sexual penetration or gynecological examinations may cause pain, as may tampon insertion. In more severe cases there can be ulceration or scarring.

What causes a fissure of the posterior fourchette?

The skin can become inflamed or fragile, and it’s not always clear why. This most often happens because sexual intercourse or gynecological examinations, and regardless of the intensity of the symptoms, they usually die down within a few days. The problem is more likely to affect premenopausal or postmenopausal women.

This type of fissure can also be the result of childbirth, when a tear or episiotomy wound fails to heal correctly. However, it can occur regardless of whether a woman has given birth. It might happen because of a straddle injury, and another common reason for posterior fourchette fissures is pelvic floor muscle tension - in particular when this has caused vaginismus.

A posterior fourchette fissure may also happen because of secondary infections or inflammatory skin conditions including:

Vulvovaginitis from thrush (candida albicans)
Bacterial vagninosis (BV)
Genital herpes
Vaginal atrophy
Contact dermatitis (caused by allergy or irritants)
Lichen sclerosus or lichen simplex
Seborrhoeic or atopic dermatitis
Aphthous ulceration

Conditions that cause collagen mutations that can make the skin weaker such as Hyper Mobile Ehlers Danlos can also contribute to fissures. Histamine intolerances can also cause weak tissue in this area.

As you might imagine, external influences and infections can traumatize and re-traumatize this delicate piece of skin. Even if the fissure heals, it is possible that a new fissure can be caused at the first attempt to stretch the vulva, even gently.

How do you know if you have a posterior fourchette fissure?

It may be obvious to you already, depending on your symptoms. A doctor can confirm this on inspection in most cases. In case of vaginal infections or STIs are causing it, swabs may need to be taken to rule those out.

How to treat posterior fourchette fissures

How you treat this fissure may depend on the underlying cause. For example, you may need some treatment for the underlying infection or condition in order for the fissure to heal itself.

When sexual intercourse is the cause of your fissures, try using a water-based lubricant and changing your sexual positions so that you can control your movements. If you have a tight pelvic floor, you may need to do pelvic floor stretches.

However, some of the more immediate things you can do to ease your symptoms include:

Using vaginal moisturizers or creams like Neueve to calm, lubricate and soften the skin
Taking warm sitz baths
Using vaginal dilators to gently encourage the skin to stretch without tearing
Applying topical anesthetic cream (such as lignocaine jelly) when you’re in pain

It is also a good idea to avoid irritants. Change up your products for natural, gentle products and don’t allow soap, spermicides, scratchy panty liners or perfumed products to come into contact with this delicate area.

One way or another, you should be able to find a way to heal your posterior fourchette fissure, even if it means being a little patient and trying a few options. Nobody wants to live with chronic pain, but the chances are you won’t have to - there are products and services designed to help you heal, so be sure to make the most of them!