As recent as ten years ago, many docs did’t know the term “vulvodynia.” The condition has been around since the first report of symptoms consistent with the condition published in the medical literature in the 1870’s. That’s 150 years ago. Most docs had not heard of vulodynia even by the turn of the century in 2000. Today nearly all gynecologists know the term vulvodynia and understand the symptoms. But there is nobody I know of,  except myself, claims to have a treatment that consistently works.  I 1997 all the vulvovaginal experts in the world who were gathered at Beveno, Italy for the ISSVD XIV World Conference scoffed at me for suggesting external irritants had anything to do with vulvodynia. Today, avoidance of external irritants is the first thing knowable vulvologists teach their patients. There are many names for vulvodynia, all of which make no sense because none of them are etiology based. Because I believe I have discovered the etiology of vulvodynia, I have divided the vulvodynia patients into two diagnostic groups; EIV stands for External Irritant Vulvodynia and AFV stands for Altered Vaginal Microflora Vulvodynia. I find vast majority are AFV patients. It’s easy to know the distinction because, AFV patients have Altered Vaginal Microflora on Vaginal Fluid Analysis. I presents these findings at the ISSVD  World Congress XVII in Queenstown New, Zealand in 2006. All but four of the worlds vulvovaginal experts scoffed at me.  EIV have normal flora. It’s an objective finding. However, once the vestibule gets sensitized by the irritant vaginal secretions in AFV, they act just like EIV patients because external irritants exacerbate their symptoms as well.

So now you understand, all vulvodynia starts from irritation of the vestibule which is made of different embryologic tissue called Endoderm compared to the tissues lining the vagina above bing Ectoderm and lining the ‘more exterior’ vulva below also derived from Ectoderm. In some patients, the irritation at the vestibule level triggers pelvic muscle tightness called Levator Ani Syndrome or Pelvis Floor Spasm or Pelvic Floor Tension Myalgia. This is why you hear of some docs prescribing PT. This is miss-guided because it will usually make the symptoms worse for several months then the symptoms will get perhaps 30-40% better. It’s expensive. If the vulvodynia is treated correctly so that the burning resolves, the pelvic floor muscle tightness goes away with no more trigger factor. I believe most docs that are experiencing success with vulvodynia patients, are treating those of the EIV type. EIV will completely resolve with just avoidance of irritants, it doesn’t matter what else from the long list of treatments available. See my Blog of Jan 2023.  AVF patients usually respond between 30-50% from just avoidance of external irritants alone. But this large group will not be cured unless they have treatment to fix the altered vaginal microflora. This is where The Fowler Gyn Approach stands above and beyond what else is out there.

The most unique feature is the use of advanced diagnostic testing with qualitative Vaginal Fluid Analysis testing (VFA Test). Other gynecologists continue to use the century old technique of Wet Preparations. Fowler Gyn International Laboratory is CLIA certified and utilizes reagents, staining and quantification techniques with analysis under phase contrast microscopy. It appears that Dr. Fowler is the only gynecologist in the US that has CLIA certified laboratory dedicated to the complex analysis of vaginal constituents. Moreover, Dr Fowler discovered the etiology  of a set of related chronic vulvovaginal conditions; vulvodynia, chronic vaginal bacterial infections, recurrent yeast infections, urinary frequency & urgency w/o bladder cause, recurrent UTI’s w/o bladder cause. For instance, the rest of the world believes that vulvodynia is a nerve condition involving the skin of the vulva. Dr. Fowler discovered vulvodynia and the rest of these conditions have a common underlying etiology known as vaginal dysbiosis. He has developed and perfected treatment protocols over several decades which required numerous patient-years observation. There has not been another medical practice in the country posting the number of testimonies as shown for the Fowler Gyn Approach. Its’ quite clear that the exceptionally high response rate has led to more social media buzz than virtually any other vulvovaginal physician in the country.

Based on the VFA test results and your hormone profile(HP), the FGI Approach uses two to six vaginal ingredients, collectively known as the Vaginal Rejuvenate Therapy (VRT) for therapy.

The considerations in the HP are as follows: your age, proximity to menopause, factors that influence your endogenous estrogen production such as lifestyle stress, exercise and body weight, whether you still have sexual arousal wetness and a q-tip assay for vaginal moisture which you can preform.

While the rest of the medical world still believes that vulvodynia is a condition limited to the vulvar skin and nerves, the FGI Approach recognizes that it is secondary to the underlying etiology. Specifically, the conditions of vulvodynia, chronic bacterial infections from Gardernella Vaginalis which is an indicator of possible BV or one of the the other 30+ bad bacteria, recurrent yeast, chronic vaginal odor or discharge, or urinary frequency/urgency without a blabber cause, are all caused by altered vaginal microflora or in some cases of vulvodynia, by exposure to external irritants.

The vaginal secretions in cases of altered vaginal microflora change from neutral to an irritant. This does not hurt the tough Ectoderm of the vagina but just up inside the opening of the vagina, the lining of the vagina changes to Endoderm, a rim about 1/2” wide, flanked on both sides by Ectoderm. The Endoderm is of different embryologic origin than the Ectoderm. In fact this is the only area in the human body, including men and women, where Endoderm is exposed to the outside environment. It is the Endoderm that is prone to getting irritated by stimulants and becoming inflamed. It is the inflamed Endoderm that stimulates the underlying nerves of the vulva. You see everybody else in the world as far as Dr. Fowler can determine, treats Vulvodynia in particular as a condition of the skin and the nerves. Now you see that’s not; the skin and nerve irritation are secondary to the underlying cause of altered vaginal microflora and/or external irritant exposure.

These conditions require two-six vaginal medications to correct, known as Vaginal Rejuvenate Therapy.

The etiology of chronic vaginal burning pain, a condition come to be known as Vulvodynia, eluded physicians for over a century. Hope for relief from the pain was dismal. Internet stories abound of women having their lives ruined due to inability to concentrate at work, engage in intercourse, exercise or enjoy social functions. That all changed when a Mayo Gynecologist,  R Stuart Fowler, M.D. discovered the underlying etiology. There proved to be two types. The most common etiology is altered vaginal microflora where the vaginal secretions turn from a neutral to an irritant. Dr. Fowler created the designation, Altered Flora Vulvodynia, AVF. The second much less common etiology arises from irritants in common hygienic products, designated External Irritant Vulvodynia or EIV. This resolves with the change in products that  get in contact with the vulva. It took years for Dr. Fowler to develop a way to correct the underlying vaginal microflora of women with AFV. It proved difficult because each woman requires an individualized approach. Although it’s one approach that fits all, it’s not one treatment fits all. Now Dr. Fowler has 42 protocols for women with Altered Flora Vulvodynia. Each woman goes into the algorithm based on her Hormone Profile (HP) and results of the VFA Test. The VFA test is a quantitative analysis of the constituents of the vagina. During treatment, this test also provides objective evidence of how close the flora is approaching normal. This treatment has proved a success in thousands of women. Unlike the dozens of “bandaid” therapy available for vulvodynia patients, the Fowler Gyn International approach provides a cure for both underlying etiologies of vulvodynia.

There is trick to getting Vulvodynia to totally resolve. One must have a treatment formula that will allow the vulvar skin, particularity located in the vestibule, to totally turn over several times under perfect non-irritated conditions. It seems all gynecologists in the world have been taught and believe, except for the experts at FGI, that vulvodynia is a condition of the vulvar skin and nerves. In truth, that’s secondary to the real etiology. But the vulvar skin, especially the vestibule is where the pain emanates from. Treating the skin and/or the nerves is only bandaid therapy covering over where the stimulus acts. However, to have an effective treatment, it must protect the vulvar skin from irritants until the skin has turned over 5-6 times. In the forth thru sixth time when the skin turns over, the cells lying next to the nerves are no longer irritated and no longer stimulate the nerves.

The vulvar/vestibular skin is constantly turning over. The newly forming cells start at the bottom of the skin known as the basement membrane and gradually push their way to the top layer as they maturate. When they reach the top, they detach and break away to join the vaginal secretions, making room for newer cells growing up from below. It takes roughly one month for new cells to get all the way to the top layer, meaning the vestibular skin you have now will be totally replaced in 4 weeks!

The turnover or shedding of maturated cells provides vaginal secretions with a high nutrient content for lactobacilli. The turnover varies from a few in number to a larger number of cells over a given time frame. This exposes more or less immature cells to external/internal stimulants. This is why as FGI treatment proceeds, symptomatically it is common to have a few good days followed by some bad days, then a good week or two followed by a few bad weeks and so forth. The more new cells exposed to irritants, the more sensitive the vestibule feels. After approximately 4-6 turnovers, the sensitized skin cells are fully replaced by non-sensitized cells which no longer stimulate the nerves and then the symptoms finally resolve for good, until another “vaginal insult” occurs. However, the longer the vulvar skin does not get influenced by external irritants or vaginal insults, the more reserve the skin develops. After 1 year of being asymptomatic, the vulvar skin can withstand normal insults like exposure to harsh hair shampoo, saliva, perspiration, fragrance, vigorous intercourse, brief hormonal changes, etc. Once most FGI clients are out 3-5 years, they often nearly forget their horrible years with vulvodynia. Unfortunately, most women do get occasional extreme exposure to irritant or significant hormonal change which causes a relapse every 5-10 years or so. Fortunately, the experts at FGI know how to adjust their protocol based on VFA testing and the condition remits quite quickly again for years more symptom free living.

I suffered for nearly 20 years with discharge, painful sensitivity and feelings of inadequacy because of my condition. Other gynecologists dismissed my symptoms.  It got to the point I couldn't even consider having sex with my husband. Finally, a new gynecologist recommended Dr. Fowler. He was the first physician to take my problem seriously, and to actually know what was wrong with me and have a solution! It took a minimum of 6 months to really start to feel better, but after 20 years of misery, what is 6 months? I actually started feeling like a regular woman. I could enjoy sex again. I didn't have to constantly change my underwear or wear pads all day because I wasn't wet and sticky. I didn't tear constantly. I didn't itch uncontrollably. By the time I'd been on Dr. Fowler's regimen for a year, I could hardly believe I'd spent so much of my life in such misery. I am still on his regimen years later because it works! I can't thank him enough for giving me quality of life again.  J. Tempe, AZ

Look at it from a doctors perspective. Who wants to take on a patient that has already seen 20 doctors for a condition that is destroying her life? Just the very thought of it is daunting to most physicians. Truth be known, even gynecologists prefer not to see women with vulvodynia because they have no idea how to treat them. Some attempt to try different approaches they have “heard about” primarily because they can code the visit as a 45 or 60 min problem oriented appointment with excellent billing fee from most insurance companies. But at some point the patient figures out they are just “trying things” without having any experience in their use and not able to give them any assurance for success. Dr. Fowler not only treats vulvodynia patients but even advertises on the web to find them. Consider the following patient:

“My symptoms began 10 years ago. I think I went to see about 20 doctors and they diagnosed me with different conditions. I would pray to God everyday that I would find the right doctor to treat this condition. Finally, while I was doing my research online I found Dr. Fowler's website. I made an appointment and I thought well I'm going to give it a try. He was able to diagnosed me with a condition called vulvodynia and gave me a treatment that has worked very well. Now I'm doing a lot, a lot, a lot better, I'd say 80% better. Dr. Fowler is an angel sent from God. My life has changed so much. My sex life has changed to be more enjoyable, the burning was just so bad it made me tired. After work I would just have to come home and just lay down. Now the burning is almost gone. I love Dr. Fowler, he is the best doctor in the world.” G. El Paso, Texas.

Not only is vulvodynia Dr. Fowler’s #1 expertise, he feels that God has been given him extra insight into the diagnosis and etiology of vulvodynia and it’s his obligation to help women with this dreaded condition. There are still some gynecologists out there who are not aware of this condition known as vulvodynia, but the majority now know what it is but have no idea how to treat it. The reason being, they only seen one vulvodynia patient every six months so they never get the patient volume to have any proficiency. How did Dr. Fowler gain his expertise? Working as a gynecologic consultant at the worlds most renowned referral medical center, the Mayo Clinic, patients with vulvodynia were referred to Dr. Fowler from all across the United States. After several decades of clinical observations and research, Dr. Fowler discovered the underlying etiology and how to successfully treat it. Very few physicians ever get the opportunity to be in such a unique position to obtain experience. Also Dr. Fowler resorted to the use of more advanced technology for analysis of vulvovaginal problems then is available in standard gynecology practices. This allows for the objective follow-up available at FGI on the progress towards recovery.