His and Her Health

I have a tear or fissure in the posterior fourchette which makes intercourse just about impossible. Every time I do have intercourse, it splits and the pain is severe. It was not diagnosed by several run of the mill gyns, so I went to a specialist at a major university medical center (I don't know if I can name it here so I won't) who made the diagnosis and has been treating it for about 6 months with Estrace both inserted vaginally (1/2 applicatorful 2 times a week) and applied to the area every night. No luck. She has told me that I will need to have it repaired and suggested a Z-plasty procedure. However, she noted that the down side is that it might not work - in which case I will need to have it redone by a plastic surgeon who will do a graft. She suggested that I have a consultation with him, which I have not done yet as I am awaiting insurance approval. At any rate, my question is whether I should have her do the procedure or the plastic surgeon do it. My thinking is that why take a chance on having to have surgery twice - just let the plastics guy do it and be done with it. It is very difficult to find a plastic surgeon who does this kind of work and I couldn't find any on my insurance plan, so it's going to cost me a whole lot more for a plastic surgeon to do it. The up side, though, is that if a plastics guy does it, it shouldn't have to be done again. I should also add that I'm 58 years old and have been on premarin for about 14 years since a total hysterectomy. I would really appreciate some feedback as I haven't been able to get much information.
Thanks.

Hi Phyllis-
What was the "diagnosis" made by the Gyn doctor who's recommending surgery? It's hard to comment without knowing that.

posterior fissures should only be treated with a modified perineoplasty not a z-plasty.

It should only be done by a surgeon who has done many of these procedures because if done incorrectly it can cause scar tissue formation.

<small>[ 04-05-2006, 09:41 PM: Message edited by: Moderator ]</small>