If you have associated itching and the skin feels kind of sticky with or without “paper cuts or cracks,” you probably have a condition called Lichen Sclerosus. If can be very subtle as far as the clinical signs are concerned but still very symptomatic. Unless you visit a gynecologist with a trained eye you will likely be told that ‘everything looks normal.” There may of may not be whitening or hypopigmentation of the peri-vaginal and peri-anal tissues in subtle to mild cases. The condition often goes undiagnosed for years until evaluated by a vulvovaginal specialist. These are either gynecologists or dermatologists with expressed interest in vulvovaginal conditions.

Moderate to advanced clinical signs include fusion between the labia minora (small lip) to the labia majora (large lip) and peri-clitorally. Chronic non-therapy can lead to resolution of the labia minora into the labia majora such that the labia minora disappear over time. Midline fusion often is present at the base of the vagina in the posterior fourchette commonly extending out onto the bridge of skin between the vagina and anus known as the perineal body. Fusion in this location can reduce the caliber of the vaginal opening leading to recurrent tearing with intercourse. Hypopigmentation or whitening of the skin can occur in a splotchy distribution or in a very even, symmetric distribution. When it surrounds both the vagina and peri-anal areas it is referred to as the “key hole” distribution on account that the area resembles the old fashioned skeleton key.

The diagnosis is made on visual clinical signs. While the majority of the medical literature says that the tissues should be biopsied, this is only necessary in a small percentage of cases  where there is thickening (leukoplakia) or non-healing fissures or ulceration of the skin. In this setting pre-cancer and/or vulvar cancer needs to be ruled out.

The condition is not infectious or contagious but it is chronic. Meaning there is no cure but it can be managed. The etiology (what causes the condition) is unknown but is thought to have some autoimmune propensity but not to the degree that the diagnosis justifies searching for other autoimmune disorders.

The condition has a high rate of response from a symptom standpoint with a tapered course of super-potent or intermediate potent topical corticosteriod depending on degree of the condition. In FGI’s opinion, many doctors make the mistake of treating only episodically when symptomatic. The experts in vaginalhealthCare at FGI believe lichen sclerosus is only properly treated when maintenance therapy with low potency corticosteriod is instituted after the initial course to prevent progressive changes of the skin, relapses in symptoms, and to lower the risk of developing pre-cancer/cancer. This condition requires an in-office evaluation at FGI. Come to the experts!

When the “good” bacteria in the vagina, the lactobacilli, counts are low, the other 30+ “bad” bacteria that are normally in the vagina at low concentrations proliferate and become the dominant strains. They take over. If a vaginal bacterial culture is done in this setting, it will grow out something like Beta strep, Enterococcus, E. coli, Klebsiella, Gardnerella Vaginalis or some other bacteria that can be normally found in the vagina. This simply reflects what specie of bacteria has become dominate in the vagina at that time. In does not usually represent an infection. If antibiotics are prescribed, only a transient response will likely occur. Sound familiar? The treatment that is really needed is to correct the underlying reason for the shift in altered vaginal micro-flora. Find out how at FGI.

At this point you may be asking yourself, if therapy directed to underlying altered vaginal micro-

flora is so superior for the spectrum of symptoms including chronic vaginal discharge, vaginal

odor, itching, and vaginal burning, stinging or rawness then why isn’t it widely utilized in the

United States?

The primary reason is that practitioners have relied on a century old technique for the analysis

of vaginal secretions known as “wet preps” and patterns of altered vaginal micro-flora have gone

totally unrecognized. The new technique of quantitative analysis of wet preparations was

published by Dr. Fowler in a peer reviewed medical journal for worldwide viewing in October of

2012. He had been using the technique it for years; few others worldwide do so. It takes a

physicians significant time, dedication, and investment in equipment to offer this level of

expertise for very little reimbursement based on the current diagnostic codes so there is little

incentive for physicians to make the overall investment. Consequently, this test will not likely

to be routinely offered in gynecologic practices for many years to come. FGI wishes to make this

advanced diagnostic technique and treatment available to all US women.

Do you wonder why you have seen so many doctors, so many times for the same problem? Only to be told the same thing, only to be treated by “let’s try this this time,” only to have the symptoms return? This is the story for many American women suffering from chronic symptoms which can include:

• Irritating vaginal discharge
• Persistent vaginal odor
• Recurrent vaginal bacterial or yeast infection
• Burning, rawness, and stinging at vaginal opening
• Burning pain on sexual penetration

Numerous women with these symptoms have sought out Dr. R. Stuart Fowler, Gynecologic Vaginal Subspecialist, with a bag full of ineffective treatments and remedies. US practitioners are conventionally trained to evaluate for 4 potential causes of vaginitis…but it’s NOT that simple. While your symptoms may mimic one of the four common types of vaginitis, your actual diagnosis may not be any one of them! Fortunately, there is a better way to treat these problems. Dr. Fowler’s approach is to treat the underlying problem in vaginal health rather than to put a band aide on it by treating only the symptoms.

During two decades of clinical observation and research at the Mayo Clinic, Dr. Fowler used phase-contrast microscopy and added new solutions, stains and gradient slides to advance the diagnostic capability of the century old method of wet preparations for evaluating “vaginitis.” As his techniques evolved, he delineated a spectrum of “Altered Vaginal Micro-flora Patterns.” In 2007, Dr. Fowler proposed a new Vaginitis Classification System that expands the number of vaginitis types to ten. Reference: Fowler, R.S. Expansion of altered vaginal flora states in vaginitis. J Reprod Med. 2007 Feb;52(2):93-99.

To determine if you have an underlying altered vaginal flora pattern, Dr. Fowler recommends that you undergo the New Revolutionary Vaginal Fluid Analysis Test (VFA Test). Reference: R.S. Fowler. Quantification of normal vaginal constituents using a new wet prep technique.  J Low Genit Tract Dis. 2012 Oct; 16(4):437-441. Take the guess work out of whether or not the vagina is in a good state of health or not. Then get treatment directed at correcting those parameters. Get access to this advanced testing by becoming a client of FGI online at FowlerGynInternational.com.

FowlerGynInternational.com (FGI) offers new hope to women suffering from vaginal symptoms that have not been adequately addresses or responded to prior treatments. There are tens on thousands of American women with recurrent or refractory vaginal symptoms actively searching for a solution their problem.  FGI was organized in May of 2013 by R. Stuart Fowler M.D. to provide expert care to this group of women. Dr. Fowler is a board certified gynecologist who did his residency at the Mayo Clinic in RochesterMinnesota and then spent the next 20 years on staff  at Mayo Clinic Arizona specializing in vulvovaginal disorders. He recognized a great opportunity to provide more women access to high quality vaginal healthcare by moving his services online. FGI offers services for the following:

• Chronic vaginal discharge and/or odor, itching, irritation
• Recurrent bacterial infections or yeast
• Burning pain &/or pain with intercourse at vaginal opening
• Vagina too tight/tearing, or the vagina to short
• Refractory vaginal dryness
• External genital skin sensitivity, irritation, or dryness
• Sensation of urinary urgency/frequency in the absence of bladder infection
• Recurrent bladder infections without a urologic source.
• Medical diagnoses include vulvovaginitis, recurrent BV, recurrent yeast, vulvodynia, vulvar vestibulitis, vestibulodynia, intriotal dyspareunia, and superficial dyspareunia, vaginal stenosis and vaginal foreshortening.

On the website, potential clients register and complete online medical questionnaires. Then the client receives a call from FGI to clarify the details of their vaginal problem. As part of the evaluation, if indicated, clients can receive the revolutionary Vaginal Fluid Analysis Test (VFA Test). This analysis identifies constituents in the vaginal secretions that indicate the state of vaginal health. The results help guide the type of treatment needed to correct any underlying altered vaginal micro-flora patterns. Special hygienic products are also recommended in certain conditions to prevent ongoing sensitization due to unsuspected chemicals in ordinary skincare products. Some client also requires vaginal dilators as part of their therapy. Attention to all aspects of each condition is warranted otherwise the symptoms persist.

FGI clients may register for Virtual Services where they get the best of both worlds- the vaginal health knowledge and expertise of FGI in Arizona delivered to the privacy and convenience of their home. The other option is to register for a traditional In-Office visit at their headquarters in Scottsdale, Arizona. Either way, clients get advanced diagnostic techniques for their vaginal problem and an individualized treatment protocol tailored to their symptoms taken in context of their general medical history. This evaluation and treatment approach has already been used with success by thousands of women across the US. Check out the numerous motivating success stories from women treated with Dr. Fowler’s protocols under the button Testimonials. If you are ready for expert care, let FGI assist in the goal to resolve your vaginal problem!