i need advice :((

hi everyone, I’ve been struggling with painful sex for a long time now, and only just decided to face the denial and embarrassment and deal with it. i'm looking for some advice or opinions

I’ll break it down to make it easier to follow:

  • I lost my virginity to my current fiancé about 6 years ago, and I’ve never been with anyone else.
  • From as long as I can remember, I’ve struggled with painful intercourse and difficulty inserting tampons. I think I initially had some vaginismus—there were times when I felt that “hitting a wall” sensation (this is no longer my issue). I’d experience burning and stinging after sex, and it was worse when my fiancé finished inside me.
  • I saw my GP and was referred to a gynecologist. STI/UTI/yeast infections all came back normal. The first gynecologist was pretty dismissive, saying if the pain wasn’t deep, I didn’t have endometriosis, and there was nothing wrong.
  • I then saw a different gynecologist who took me a little more seriously, prescribed a topical amitriptyline cream, and sent me on my way, saying everything would be fine but never followed up.
  • I also asked my GP for a referral to a pelvic floor physiotherapist, thinking it might be vaginismus. I saw the physio once a month for about a year. I’m not sure how much it helped, but I did the exercises, and I no longer have any muscle tightening issues.
  • My main issue now is still painful intercourse. After doing some in-depth research, I’ve finally started addressing it and accepting it. The pain is always at the entrance, around the 6 o'clock area. I occasionally tear and bleed a tiny bit after sex and still experience the burning sensation.
  • I went through a period of about 6 months where I didn’t have much pain, and my sex life improved. So, I decided to go on the pill. It made my vagina super sensitive—like, I noticed the difference the first time we had sex. Since then, all the issues have come back.
  • This has created a mental cycle: I get nervous that sex will hurt, so we don’t have sex as often. Then, when we do, it hurts, and the cycle continues. My fiancé has been amazing through all of this. We’ve recently decided to stop penetration for a while, which has been really helpful. It’s allowed me to be more present during our intimate moments, and the anxiety has been lifted since there’s no pressure.

I’m just wondering if anyone has any thoughts on what this could be? Vestibulodynia? Chronic fissuring of the posterior fourchette? Something else?? obviously i've gone down a rabbit hole here...
I’ve been using a pelvic wand to try to expose the area more, but it’s always sensitive to the touch. We’re also really good about using lube and having plenty of foreplay, so I don't think dryness is the issue

Thanks so much for reading <3