'I can't have sex without pain. I feel unloved and unwanted': A woman on Instagram has powerfully opened up about vaginal tearing, and so many people can relate

, 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.

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.

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.

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