Burning and pain in the intimate area and slight bleeding that often alarms. “These are some of the signs that may indicate the presence of intimate fissures, also called vulvar fissures, which manifest as small lesions on the skin or mucous membranes of the external genitalia,” explains Dr. Alessandra Valerio, a specialist in gynecology and obstetrics in Ferrara.
“Often persistent or recurrent, the “cuts” on the vulvar area are extremely painful: they can give itching, burning, a strong sensation of pain but also create small bleedings that can appear sometimes after sexual intercourse, often difficult precisely because of the presence of the intimate fissures, or following the practice of physical activities that involve rubbing of the intimate area such as cycling or running.” But that’s not all. “The persistence of lesions and the painful condition can negatively affect sexual habits and worsen the quality of life of the sufferer,” comments the expert
A complex picture
What can intimate fissures be due to? “The causes that can lead to vulvar lesions can be diverse,” the gynecologist continues. “Therefore, it is essential that in the presence of pain, burning, and small bleeding, one should always turn to the specialist who can check for external intimate fissures through careful listening to what the patient reports and upon observation of the genitals. In some cases there may be a need to perform a culture or biopsy to precisely define the clinical picture.” These are the main causes of vulvar fissures.Organic causes. “They are linked to the presence of inflammatory dermatoses due to diseases such as lichen or psoriasis,” Dr. Valerio continues. “These are in fact chronic dermatological pathologies that result in decreased tissue elasticity and thus promote the appearance of the painful cuts.”Infectious causes. “Fungal, bacterial, and viral infections can be at the origin of intimate fissures: therefore, a culture examination is needed to detect them,” Valerio points out.Mechanical causes. “Intimate fissures can form as a result of sexual intercourse, particularly if the mucous membranes are not sufficiently lubricated, as can happen in the presence of vaginal dryness, a condition that particularly affects the menopausal phase but not only,” the expert continues. “Firm and repeated rubbing in the vulvar region, caused, for example, by wearing tight clothing or playing sports, can also cause small vulvar lesions.”Hormonal causes. “The estrogen deficiency that occurs at certain stages of female life such as lactation and menopause or as a result of taking oral contraceptives results in thinning of the genital mucous membranes resulting in less elasticity and a dry condition of the mucous membranes, exposing them to a greater risk of being damaged,” continues Gynecologist Valerio.Environmental causes. “Exposure to irritating factors such as may be, for example, the use of detergents unsuitable for the intimate area or the constant use of panty liners or low-quality tampons are causes of inflammation and a consequent increased fragility of the tissues,” the expert specifies. “Finally, it should not be forgotten that often in association with vulvar fissures there is a condition of contracture of the pelvic floor muscles that can result in chronic pain syndromes such as vulvodinia,” the gynecologist points out. “In this case, the picture is very complex and needs careful evaluation since it can be difficult to tell whether the painful condition appears secondary to intimate fissures or vice versa: however, it is basic to address the problem in its entirety so that the patient can be restored to a more serene living condition, in all aspects, including sexual.”
How to treat intimate fissures
“The treatment of external intimate fissures depends directly on the root cause of them,” the gynecologist points out. “An infection needs to be eradicated by targeted therapy, lichen sclerosus requires a specific treatment protocol, estrogen-dependentvulvo-vaginal atrophy benefits from hormone therapy, even if only local. If signs of pelvic floor contracture are present, a course of physiotherapy leading to relaxation of the area will be indicated. In any case, vulvar fissures can benefit from adequate hydration of the mucous membranes with emollient, moisturizing and soothing creams. In some cases, a therapeutic option may be hyaluronic acid infiltration to promote connective tissue regeneration and improve trophism and elasticity. Very rarely there is a need for a surgical approach with excision of the lesion and reconstruction using plastic surgery techniques.”
Good habits to adopt
“Beyond the specific treatment that must be indicated by the specialist, some simple hygienic-behavioral rules are useful to reduce the risk of recurrence and chronicization of the problem,” comments Dr. Valerio. *Adequate intimate hygiene helps to maintain the trophism of the part: little aggressive detergents are needed, free of irritating, allergenic or perfuming factors, with a pH appropriate to the age to be used in small amounts for washing with lukewarm water.
* Carefully chosen clothing: tight-fitting garments in the genital area that cause friction during movement are to be avoided, always preferring underwear made of natural, breathable fabric. * The use of plenty of lubricant during intercourse: avoids rubbing that can damage the mucous membranes.