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 your age, hormone profile and results of the VFA test, Dr. Fowler selects the proper place in the algorithm of mixed bio-identical hormone doses that you should start with. There are 42 different doses in the FGI algorithm. It takes 4 months to allow the majority of the response that will be induced by a particular dosage. The progress is measured by the change in the six VFA parameters.

Dr. Fowler has found that each woman has a narrow band-width to which they respond. There is no response with too little hormone and there is no response if too much hormone is given. Women with these conditions are different than the general population of women in that their vaginal mucosa only responds to the higher echelon of hormone levels and it must be the proper ratio of bio-identical hormones and it must be formulated in a base that will not cause any reaction. If any of these three things is wrong, the treatment will fail. The base is the medium through which the hormone is delivered. These are all vaginal preparations; the treatments are NOT given orally.

Women who have these conditions should look at it this way. You have a vagina like that of a jet engine compared to and automobile engine. As long as the jet gets it’s high octane Jet A fuel then the engine produces amazing horsepower. If it receives the lower octane fuel of Mogas, it sputters and spurts. In real terms, the vagina shrinks in caliber and length, the mucosa becomes dry, and an altered vaginal microflora pattern develops. This micro-environment is conducive to the growth of aberrant bacteria and yeast.  The vaginal secretions change from being soothing to an irritant. These secretions may have a new odor and plentiful enough to cause a new discharge. These secretions work their way down the vagina and onto the vestibule at the opening of the vagina. The vestibule is about 1/2” wide and made of endoderm. It is the endoderm that gets sensitized and causes burning, stinging or rawness. This tissue is flanked on both sides by ectoderm of the vagina and the ectoderm of the vulva. The ectoderm is more resilient and generally does not get sensitized.

The VRT treatment is aimed  at getting the flora to change back to normal, then the secretions are no longer irritating and the variable symptoms of burning, rawness, stinging, itching and/or urinary frequency/urgency resolve. Symptoms which are a direct result of the altered flora such as dryness, odor and discharge also resolve.

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.

You may be tempted to order one of the many types of vaginal microbiome test kits available on the internet to determine if you have vaginal dysbiosis. These tests range between $60-200.00. While they sound impressive because they use next-gen sequencing and/or metaqgenomic sequencing.  they are stuck on making one of 4 types of vaginitis; bacterial vaginosis (BV), trichomonas, yeast or atropic vaginitis. Not one of these has been the underlying etiology of chronic vaginal disorders diagnosed and treated by FGI. Many of the tests also look for the STD’s chlamydia and Neisseria gonorrhoeae. Neither of these is an underlying etiology of the chronic vaginal conditions  either. What women need for the chronic vaginal symptoms addressed by FGI is a Vaginal Fluid Analysis (VFA ) test.

The VFA test was developed and published by Dr. Fowler while he practiced gynecology at Mayo Clinic. (In 2011, at the ISSVD World Congress XXI in Paris France, Dr. Fowler presented “Quantification of Normal Vaginal Constituents by New Wet Prep Technique,” subsequently published in: J Low Genit Tract Dis. 2012 Oct;16(4):437-41. The VFA test is  preformed exclusively at the CLIA certified Fowler Gyn International Laboratories (FGIL). It’s located at FGI headquarters and results are available in 7 minutes. This means you get your results and protocol at your appointment. FGI has the only laboratory in the country that I know of dedicated to the evaluation for the vaginal constituents. It’s a one of a kind.

It gives the relative quantitative measurement of constituents in the vagina that reflect vaginal health. These include the maturation index of squamous cells, the relative concentration of squamous cells and the pattern of bacteria on the cells; the presence, concentration and type of wbc’s; the relative concentration and quality of lactobacilli; the relative concentration of non-lactobacilli, anaerobic and aerobic bacteria; and the presence and relative concentration of blastospores and/or pheudohyphae yeast elements.

Thousands of women have been treated with success at Fowler Gyn International (FGI) with this breakthrough approach. It has been over a century that some of these conditions had no known etiology let alone any consistent successful treatment.  Now you can get your life back.