Expert: Norman Solberg - 4/13/2009

Question
 This isn’t really a contraceptive question, but there isn’t a general gynaecological category. I’ve been suffering from cuts to my vagina and vulva for more than a year. These only appear after sex and heal within a day or two. I am in a long distance relationship and see my boyfriend once or twice a month and do not suffer any discomfort in the interim, so I’m pretty sure this is intercourse related. I get small ‘paper cut’ type cuts around the entrance to my vagina on the inner labia and a single, recurring, deeper cut about 5-10mm inside my vagina on the wall closest to the anus.  There is often a very small amount of blood. We always have lots of foreplay, so I am very relaxed and lubricated by the time any penetration takes place. We also use plenty of lube on top of this, but I still inevitably tear, even if everything is completely slick. I occasionally experience a burning pain deeper in my vagina centred on the wall closest to my bladder during sex, but this is much less frequent than the cuts.
 From what I’ve read on the internet, this seems to be a common problem among women, but also seems to coincide with their periods or leaves no discernable marks, which is not the case for me. I’ve tried switching to washing products specially formulated for the vagina, moisturising and using nappy rash cream, which all help the cuts heal faster and sooth them, but doesn’t stop them re-occurring. I also do penetrative masturbation when I am not with my boyfriend in an attempt to keep my vagina ‘open’, although when I do have sex for the first time after a few weeks, I am inevitably a little bit tighter than usual.
  Is there anything else I can try to combat this? I had the same problem with a previous boyfriend I was with (also long distance), however when I first started having sex with my current boyfriend I didn’t experience any pain. At that time we were living in the same city, but after about a month the pain returned and a month after that I moved away and have not had pain free sex since. I’ve been on a combined desogestrel/ethinylestradiol pill for five years, but don’t think this is related, as I was using this for years before the cuts started occurring.
Any advice would be much appreciated!


Answer
Hi Claire,
I've been in practice for years and seen many of these cuts.  It's interesting that I never heard anything about them during medical school or during my OB/GYN training (That was years ago).  I suspect that they're not all the same, so the same treatment may not always work.  I think in many cases it's a matter of getting a tear, perhaps from sex without enough lubrication, and thereafter the tissue has some scarring and is susceptible to re-tearing.  It may be that many cases are related to a yeast infection.  Yeast infections can be difficult to diagnose unless a culture is done.  Also, it's common for yeast infections to recur around period time, which is when many of these cuts appear.  It's worthwhile to try yeast medication, perhaps for an extended time (1-2 weeks) while also avoiding intercourse.  Extra lubrication during intercourse is recommended, to decrease friction as much as possible.  Soaps and vaginal deodorants can probably produce the cuts, perhaps due to a sensitivity reaction.  In reading the blogs it seems that stress is a common factor, and may certainly contribute.  For some women I think using estrogen cream nightly in the area may be helpful.  I doubt that herpes or birth control pills are a cause.  I know this is a long answer, but if there were a simple solution, someone would have probably discovered it by now.  I hope this is helpful.
Doctor Norm