Vulvar Granuloma Fisuratum (recurrent tearing of the vulva)

Vulvar granuloma fissuratum describes recurrent splitting or tearing of the vulvar skin.  It is often associated with vulvar skin conditions that cause fibrosis (scarring) and inflammation, such as vulvar lichen sclerosus.  It may also be associated with vulvar atrophy, or thinning of the skin due to decreased testosterone and estrogen.  It may be associated with a poorly healed episiotomy or perineal tear from childbirth or occur with overactive pelvic floor muscle dysfunction.   Fissures often occur at the posterior fourchette (the bottom of the vaginal opening); however, these tears may be anterior (on the top of the vaginal opening), around the hood of the clitoris or between the labia majora and minora.  These fissures often cause pain with vaginal intercourse, leading to recurrent tearing, splitting, and scarring.  Patients often note a small amount of bleeding or spotting when this occurs. 

Treatment

Identification and treatment of the underlying condition may resolve mild fissures.  This may involve avoiding contact irritants and application of a topical corticosteroid or hormones, as well as manual dilation with graduated vaginal dilators.  If there is no improvement with conservative treatment, a minor surgery is offered to remove the small area of fissured tissue and replace with more flexible vaginal tissue, in a procedure called perineoplasty with vaginal advancement flap.

Conditions we treat