Our website uses cookies to improve and personalize your experience. We do not sell your information. Our website may also include cookies from third parties like Microsoft Clarity, Google Analytics, Google Adsense. By using the website, you consent to the use of cookies. We have updated our Privacy Policy. Please click on the button to check our Privacy Policy.

Managing Vulvar Fissures from Vulvar Lichen Sclerosus

Managing Vulvar Fissures from Vulvar Lichen Sclerosus

Introduction

In our last post, I (Jaclyn) shared my experience with vulvar lichen sclerosus and fissures. In today’s post, we will dive deeper into the nature of fissures, why they happen with vulvar lichen sclerosus, and recommendations on healing and treating them.

*This post is evidence-based; I draw on the medical literature to share what you need to know about vulvar lichen sclerosus and fissures. Importantly, what I share is my interpretation of the science and data.

**If you found this post helpful, we’d love your support in continuing to provide important education like this. Make a donation today, volunteer with us, or share our posts in your support groups.

Vulvar Fissures in General

First of all, anyone can get vulvar fissures–they aren’t exclusive to people with vulvar lichen sclerosus. Many things can cause them, which we will highlight below. So, let’s review the basics of fissures first and dive deeper into fissures and vulvar lichen sclerosus. 

Vulvar fissures are like small cuts or tears in different parts of the vulva, which is the external part of the female genital area. Fissures will typically be quite symptomatic, causing stinging pain, especially when things like urine or semen touch the fissure (Edwards, 2004). 

While fissures can occur anywhere on the vulva, the most common areas are the fourchette (see image below) and within the skin folds (e.g., between the folds of the labia and perineum) (ibid). 

Graphic image design image showing where the labial folds, vaginal opening/fourchette, and perineum areas.

Fissures at the Vaginal Opening/Posterior Fourchette

Fissures at the opening of the vaginal/fourchette often occur with insertion or penetrative sex. The sharp, stinging sensation usually worsens when urine and semen touch the fissure, but water can also be irritating. Sometimes, the fissure is visible and will look like a reddish line. However, you may not be able to see the fissure. As the fissure heals, it may look like a very faint, thin, reddish line. 

According to Edwards (2004), most patients she sees with fissures in this area have no apparent cause. She notes this area of the vulva tends to be prone to trauma and poor healing. That said, she notes that there is a clear cause for some patients, such as infection and/or vulvar lichen sclerosus.

Fissures in the Skin Folds

The other common area where fissures occur is in the skin folds of the vulva, such as the interlabial sulci. If you haven’t heard that term before, don’t worry! I didn’t know what it was until way later on in life. 

Interlabial sulci are basically the small grooves or folds of skin between the outer lips of the vulva. Think of them like tiny valleys or creases between the lips. They're a natural part of the anatomy and can vary in size and shape from person to person. 

Another skin fold area that can fissure is the perineum.

These types of fissures tend to be more manageable than vaginal opening/posterior fourchette fissures, which take longer to heal. 

Several things, including sexual activity, rubbing/friction, or scratching, can cause these types of fissures. These fissures will also burn and sting when external irritants like urine and semen touch the fissure. 

It’s not always easy to see these fissures. You may feel stinging and pull out a mirror to see what is happening, only to find nothing. This has happened to me (Jaclyn) countless times, and I started to worry that something was seriously wrong with me. It was validating to learn that some fissures cannot be seen with our eyes and require special medical equipment to magnify the vulvar skin. If you can see it, it can look like a small tear or line in the skin. 

Causes of Skin Fold Fissures

Many skin conditions can cause fissures, especially if there is an itch component to the skin condition that leads to rubbing/scratching of the skin. These conditions include various types of dermatitis, lichen simplex chronicus, lichen sclerosus, and desquamative inflammatory vaginitis. Infections such as candidiasis (yeast), group B streptococcus infection, herpes, and HPV can also lead to fissures.

Graphic image design of different infections and conditions that can cause vulvar fissures.

Vulvar Fissures and Vulvar Lichen Sclerosus

As mentioned above, vulvar lichen sclerosus can cause vulvar fissures (Edwards, 2004; Kirtschig, 2016; Fergus et al., 2020; Fistarol & Itin, 2012). For vulvar lichen sclerosus, fissures can occur anywhere on the vulva. 

Why is vulvar lichen sclerosus skin more prone to fissuring? 

Well, it has a lot to do with the skin's texture. Lichen sclerosus causes the skin's texture to harden, stiffen, and thicken. While the topmost superficial layer of skin can appear thin, the layers immediately below are thick and stiff. This means the skin lacks mobility and elasticity. Because of this, our skin is more prone to cracking, fissuring, and tearing. (CVVD – The Centers for Vulvovaginal Disorders Lichen Sclerosus Webinar). 

Thick skin is also itchy; when we feel the profound LS itch, we may scratch and rub. This scratching and rubbing can cause small fissures around the vulva.

If you read my post on fissures last week, you know I primarily experienced fissures in the vaginal opening/posterior fourchette location, as well as in the labial folds and around the clitoris. The fissures stopped as I treated my skin and restored it to a healthier texture.

How to Treat Fissures with Vulvar Lichen Sclerosus?

Unfortunately, I could not find any papers specifically outlining the treatment of fissures due to vulvar lichen sclerosus. In the absence of this, here is what Edwards (2004) recommends for the general treatment of vulvar fissures: use of an anti-fungal (e.g., fluconazole 150mg every 4-7 days) and topical corticosteroids applied daily to the fissures until healed. The anti-fungal treatment may not be necessary if the fissure is from VLS; however, if you test positive for yeast and have fissures, the anti-fungal treatment will be important to treat the underlying infection. 

Graphic design image of ointments.

In addition, Edwards (2004) recommends wearing loose clothing to help avoid rubbing and friction and topical lidocaine to help manage pain and discomfort until the fissure heals. Jaclyn also uses a barrier cream (plain petroleum jelly for her) over the fissures to help create a protective barrier between the open wound and external irritants like sweat and urine. She also uses a peri bottle to clean any urine off the vulva after peeing, instead of using toilet paper, which she finds to irritate the skin.

A Note on Prevention

Of course, an important point to highlight regarding VLS and fissures is the importance of following an evidence-based treatment plan. Lichen sclerosus skin is fragile and prone to cracking and fissuring due to the thicker, more rigid texture of the skin. Using topical corticosteroids properly and consistently helps restore the skin to a healthier texture, making it less likely for fissuring to occur. 

Ensuring the vulva is well moisturized as well can help. You can moisturize your vulva with a balm, salve, emollient, or barrier cream. To learn more about these, click here.

What About Perianal Fissures?

Unfortunately, I (Jaclyn) could not find any papers on the treatment of perianal fissures in people with perianal LS. What her GP recommends is that she use Nifedipine ointment on the fissures, soak multiple times in sitz baths, keep the area clean, and eat a good amount of fiber to help with the easier passage of stool. I will also be starting pelvic floor physical therapy for anal fissures and will update with a blog after a few months of treatment.

We at LSSN are currently looking for an expert in this area to help answer questions – if your doctor is an expert in perianal LS, please send us their information.

Conclusion

In sum, vulvar lichen sclerosus can cause the skin of the vulva to fissure, causing small tears and cuts in the vulvar skin. These can sting and burn when external irritants like sweat, semen, and urine touch them. Topical corticosteroids and barrier creams may be applied to fissures. Wearing looser clothing and using a peri bottle instead of toilet paper may help with discomfort. 

Share what helps you manage fissures in the comments below. 

Stay In The Loop! Never Miss A Blog Post, YouTube Video, Podcast Episode, Event, Or Product Launch By Getting On Our Newsletter!

Sign up for LSSN’s monthly newsletter here.

Sign up for TLLC’s newsletter here.

Reach Out To Me

Whether you are debating booking a support call with me, have a quick question, or want to share something related to my content, I can be reached via:

Email: Jaclyn@lostlabia.com

DM: @thelostlabiachronicles on Instagram, Facebook, and TikTok.

Support Resources

Lichen Sclerosus Virtual Meetup hosted by myself and Kathy of Lichen Sclerosus Podcast – sign up here.

Feel free to book a 1:1 call with me if you struggle with grief and emotions. Simply click this link to learn more about lichen sclerosus peer support calls.

Image of a person with dark brown skin and dark hair wearing a yellow shirt sitting at a desk on a call. The title text reads, "1:1 LS Peer Support Calls, book now".

LSSN Membership sign up here.

For a more detailed list of free and paid support resources, check out my LS resources page here.

Sources Cited

Edwards, L. (2004). Vulvar fissures: causes and therapy. Dermatologic Therapy, 17(1), 111-116.

Fergus, K. B., Lee, A. W., Baradaran, N., Cohen, A. J., Stohr, B. A., Erickson, B. A., Mmonu, N. A., & Breyer, B. N. (2020). Pathophysiology, Clinical Manifestations, and Treatment of Lichen Sclerosus: A Systematic Review. Urology, 135, 11–19. https://doi.org/10.1016/j.urology.2019.09.034

Fistarol, S. K., & Itin, P. H. (2012). Diagnosis and Treatment of Lichen Sclerosus. American Journal of Clinical Dermatology, 14(1), 27–47. https://doi.org/10.1007/s40257-012-0006-4

Kirtschig, G. (2016). Lichen Sclerosus—Presentation, Diagnosis and Management. Deutsches Aerzteblatt Online. https://doi.org/10.3238/arztebl.2016.0337

The Centers for Vulvovaginal Disorders Lichen Sclerosus Webinar. (n.d.). Www.youtube.com. Retrieved March 23, 2024, from https://www.youtube.com/watch?v=vltY9mr8E68&rco=1

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Related Posts