Vulvar fissures are linear erosions that occur on the vulva. They are very rarely a primary diagnosis; instead, they represent a clinical finding in the setting of underlying inflammatory, infectious, or mechanical / traumatic conditions. Vulvar fissures are nearly always profoundly symptomatic, with patients reporting "paper cut"-like sensations, pain, stinging, dyspareunia, bleeding, pruritus, and/or dysuria. Symptoms worsen with palpation of the affected area, intercourse, and contact with foreign objects (eg, toilet paper) and bodily fluids (eg, semen, urine). Vulvar pruritus can especially contribute, since scratching, rubbing, friction, and application of topical products for relief can cause or worsen vulvar fissuring. These behaviors may also cause damage to the skin, increasing risk for secondary infection. Although vulvar fissures can occur anywhere on the vulva, they most often present on 2 primary locations: at the posterior fourchette and in skin folds (ie, interlabial sulcus, perineum, or perianal skin).

Fissuring at the posterior fourchette is typically secondary to vaginal intercourse, and there may be no underlying associated dermatosis. A retrospective review on posterior fourchette fissures found the median age of affected individuals to be around 42.5 years, with patients ranging from ages 26-78 years. Fissures in this location are associated with pain with activities such as vaginal intercourse, pelvic examinations, and inserting feminine hygiene products (eg, tampon, menstrual cup). Posterior fourchette fissures may also become chronic. When chronic or recurrent, the term granuloma fissuratum is used. Membranous hypertrophy of the posterior fourchette is the presence of a horizontal band of excess, inelastic tissue that occurs at this anatomic location, and this is often the site of granuloma fissuratum.

Skin fold fissures have a broader spectrum of etiologies, but they are most often caused by underlying infectious, inflammatory, or traumatic conditions that cause chronic vulvar inflammation. Skin fold vulvar fissures may or may not be associated with sexual activity, but sexual activity and/or bodily fluids can worsen symptoms.