One in ten British women find sex painful, according to a study by the International Journal of Obstetrics and Gynaecology. But pain can be interpreted in so many ways. What if we told you that some women can’t have sex without tearing? That sex for some women causes the same pain and trauma as childbirth? That’s the reality for Jillian Currie, 27, who founded the Queens of Eve community, which brings women suffering from all kinds of vaginal conditions together.
She candidly opened up about her experience in a recent Instagram post: “My vulval tearing happens right at the base of the vaginal opening, and only when trying to have sex (vulval pain is daily however),” she began.
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“But recently, I am tearing on both sides of my labia just from touching it to wash, or I’ve found my skin to be itchy and even from a gentle rub to relieve this it tears. Trying to shower with split skin stings so much, dabbing loo roll on there after a wee, and wearing underwear. The thought of someone else touching me fills me with dread.”
Naturally, her condition has affected her relationships, and the last time she was having “healthy” sex with a partner was seven years ago, when she was 20. Her tearing issue began during an abusive relationship which began in 2015, but to this date, Currie is unsure if there’s a link. She references ‘jock itch’, a contagious fungal infection which causes a red and itchy rash, which she says her partner at the time suffered with and so could be a potential cause for the tearing, but having had endless treatments ever since, she’s still no closer to a ‘normal’ sex life.
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Her relationships have also suffered in their own right. “The lack of sex in this relationship due to cheating on me, made my confidence incredibly low. I was never touched sexually and felt like a spare part. What made this worse is a couple of years later, my most recent partner did the same thing. Not the abusive part, but the no sex part. To have two partners back to back who didn’t seem very interested in sex has made me recoil into my shell even more. Then came the pandemic, leaving me feeling like I don’t even know how to have sex anymore. Not with confidence anyway.
“I don’t feel sexy, I feel unloved and unwanted. Like I’ve been put on a shelf, but combine that with not being able to feel sexy because I have to wear cotton big girl’s pants, always have something wrong with my vulva/vagina and can’t physically enjoy sex without pain. I feel like I would let any future partner down. They would need to be incredibly understanding.”
Cementing her diagnosis is one of the most frustrating and unsettling parts, not least for not knowing what will soothe symptoms, but for feeling like she doesn’t belong: “What is wrong with me? I was tested for LS (lichen sclerosus), but it was negative, yet most nurses I see tell me I don’t have much anatomy (a key sign of LS),” she concludes. “Is my immune system attacking itself? Am I allergic? Living without a diagnosis is hard, if you can relate, you’re not alone.”
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It’s for the same purpose behind Currie’s post – to let other women know that they’re not alone – that we’re sharing this article. And sure enough, several of Currie’s followers took to the comments section to chime in with their own experiences. “I am married and I am lucky to have such a wonderful caring husband,” one wrote. “I have provoked vestibulodunia with tearing on the posterior forcette. I worry daily it will eventually break us and he will find someone with a ‘normal vag’.”
Another said: “I feel you on the letting your partner down situation. This for me was one of the hardest feelings despite the pain. You are not alone and we’ve got you. I highly recommend psychosexual therapy to support in the journey around your previous relationships.”
And a third added: “I found your page after googling my issues. I’m now 33 and have never had a healthy sex life due to tearing. I can’t tell you how much it’s meant to me to find you and feel like I’m not alone. It’s a very miserable and lonely journey, but you’ve helped me feel less self-critical and embarrassed.”
If any of these sound like you and you’re still yet to have pinned down a diagnosis, we’d recommend seeing a gynaecologist who specialises in vaginal conditions to give you more precise advice. If you have, however, identified lichen sclerosus as the cause, which Currie initially believed to have been presenting her issues, it’s not the be all and end all.
Dr Jill Krapf, an obstetrician-gynaecologist who works at the Center for Vulvovaginal Disorders in Washington D.C. and specialises in vulvar pain, often shares insight on her own Instagram. “Women can tear during sex when the skin at the vaginal opening is fragile, inflamed, or scarred,” she tells us. “Skin can be fragile, or thin, due to lack of hormone, which we often see with menopause, or any process that decreases oestrogens and testosterone. There can also be inflammation due to an embedded skin infection, such as recurrent yeast on the vulva, or an autoimmune skin condition, such as lichen sclerosus or lichen planus.”
On the topic of lichen sclerosus, she defines it as: “A chronic, inflammatory skin condition that can lead to scarring. It often affects the skin of the vulva and around the anus. Although in the past it has been regarded as a condition that occurs after menopause, up to 40% of women noted skin changes that started prior to menopause. Unfortunately, it cannot be prevented.”
What may also be comforting to know, is that it’s a genetic condition, not something you’re doing that causes it to materialise. “The most recent research indicates that lichen sclerosus is an autoimmune condition with a genetic component,” Dr Krapf says. “This means that there is a protein or collection of proteins in the bottom layer of the skin that the body identifies as ‘not self’ and, in response, the body’s immune system brings in inflammatory factors. It is this inflammation in the bottom layer of the affected skin that leads to changes in the skin that cause symptoms and the classic appearance of lichen sclerosus on the vulva. Twelve percent of women with vulvar lichen sclerosus have a first-degree female relative with the same condition.”
Symptoms of lichen sclerosus
When asked what the most common symptoms of the condition are, Dr Krapf cited the following:
- Itching. “However, this is most often reported in women after menopause and girls prior to puberty, when the body’s natural oestrogen levels are low,” she says.
- Pain with intercourse and tearing at the vaginal opening. Why? “It was once believed that the skin in lichen sclerous was too thin,” says Dr Krapf. “However, we now know that inflammation within the skin affected by lichen sclerosus leads to decreased flexibility of the skin related to impaired collagen make-up, leading to thickening of the skin, not thinning. In this way, the skin cracks like a sidewalk, instead of tearing like tissue paper.”
- White patches on the skin with a wrinkled texture.
- Changes to the vulval appearance, including “loss of the labia minora, narrowing of the vaginal opening due to scarring at the top and bottom, and covering over of the clitoris with the clitoral hood, sometimes completely”.
Treatment for lichen sclerosus
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Medical treatments for LS
- Ultra-potent topical steroids such as clobetasol 0.0.5% ointment.
- Topical calcineurin inhibitors such as tacrolimus, pimecrolimus.
- Platelet-Rich Plasma (PRP) – injecting patient’s own platelets (obtained from blood) into the tissue.
Energy-based treatment for LS
- Photodynamic therapy.
- High intensity focused ultrasound.
- Fractional CO2 laser therapy.
Again, we implore you to see a specialist for more specific advice relating to your own case, but know that you are absolutely not alone.
