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 are three constituents in a healthy vagina. Lactobacillus bacteria, maturated squamous cells and plasma from the blood stream. This BLOG will discuss where Maturated Squamous Cells come from.

Squamous Cells: Most people think these are cancer cells. They can be but most the time the term refers to the normal cells composing the surface of  skin and the vaginal lining. Your vagina is composed of thick rugated stratified squamous mucosa. Rugated means they are folded on top of each other and stratified means they are bunched up in layers. That means the vagina lining looks like the waves in the surf approaching the beach. Specifically, the lining is not smooth but is a series of ridges produced by folding of the wall of the vaginal lining known as the mucosa. The folding in and out enables it to greatly expand for intercourse and especially for childbirth. The older a woman gets and the more sexual intercourse she has had, the rugations tend to flatten out and become less pronounced. In a healthy marital relationships, women are likely to have had intercourse 6000 times by the age of 50. Even then, most women maintain good vaginal rugations with muscle snugness and moisture given the woman has paid some attention to exercise and perhaps hormone use. The word squamous sounds like cancer because so many cancers are of squamous cell derivation. But in fact it’s the same cell line as the skin covering the human body and vagina except the vagina is non-keratinizing stratified squamous epithelium meaning it does not develop the tough outer layer composed of keratin. This means it has no potential for callus formation; a distinct advantage for the vagina.

Squamous Cell Maturation: The vaginal mucosa is the wall of the vagina. It consists of multiple layers but only four cell types each representing different stage of development. The deepest layer is composed of Basal Cells. These cell have just developed into squamous cells derived from the basement membrane. Basal Cells are the newest cells that are forming to eventually develop into the more maturated cells located further towards the vaginal surface. The next layer towards the surface is composed of layers of Parabasal Cells. Both these cell types are small with little cytoplasm, large nuclei and no nutritional content to help sustain the healthy bacteria in the vagina. If the vagina receives some estrogen stimulation then the Parabasal Cells maturate into Intermediate Cells, which have some nutritional content for healthy vaginal bacteria. If there is full estrogen loads available, then Intermediate Cells maturate into Maturated Squamous cells with tiny nuclei and large amount of cytoplasm with abundant glycogen and other nutrients for the lactobacilli species of bacterial that dominate the vagina micro-flora in reproductive age women under healthy conditions.The Superficial Maturated Squamous Cells are the cells on the top layers of the mucosal lining, meaning directly in contact with the vaginal secretions in healthy conditions. These cells are exfoliated into the vagina and are part of normal vaginal secretions. Their presence in adequate numbers are key to supplying the nutrients for lactobacilli to thrive. This layer of superficial maturating squamous cells make up the lining or mucosa of the vagina.

The Clinical Problem: I have found that women with vulvovaginal burning, stinging, or rawness AND women with recurrent vaginal bacterial or yeast infections ANS chronic odor, have something different about their vaginal mucosa. While most women respond to any type of estrogen to get their vaginal mucosa to fully maturate. Women with these conditions do not respond to any of the estrogen products made by US pharmaceuticals. This is where FGI expertise comes in. I has developed unique topical agents that stimulate the vaginal mucosa causing it to maturate. The trick is that each woman requires a little bit different formula in order to respond depending on their hormone profiling (HP) and VFA test results.