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.

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

Some women suffer with irritation consisting of dryness, chafing and itching intermittently for years thinking that it’s a mild yeast infection or sensitivity to irritants in the products that touch the vulvar tissues when in fact it’s not. Instead an vulvar condition called Lichen Sclerosus can elude doctors during it’s early stages for years causing these symptoms. Changes in the skin start out as subtle wrinking, shinyness and stickyness of the skin. As it progresses, the tissues lying adjacent to each other such as the periclitoral tissues, the interlabial folds and the base of the vagina can fuse together causing linear fusion lines. If pulled apart these fused areas can crack open causing small paper-cut fissures which brings a new symptom of burning & stinging. Also the tissues surrounding the vaginal opening can turn slightly blanched-white. This can include the peri-anal area. The whitening can be splotchy or smooth with symmetric bilateral outlines. Many doctors including gynecologists can entirely overlook the early signs of the condition. Consider the plight of the patient below:

“I was diagnosed by Dr. Fowler 3 1/2 months ago with Lichen Sclerosis. I had seen 5-10 doctors trying to figure out how to help me with the symptoms I was having, and get a diagnosis. I was so frustrated and felt like nothing was going to help me relieve my symptoms. After seeing Dr. Fowler, he helped me know exactly what I needed to do to improve, and answers came! I started feeling better quickly and learned how to manage my symptoms feeling like I can lead a normal life again! Overall I'm 80% better at this point." J. Sahuarita, AZ

Even when general gynecologists make the correct diagnosis, commonly they prescribe superpotent corticosteriods on an intermittent basis. While suprapotent corticosteriods have their role, using them each time the condition flares is not the best way to effectively mamage the condition. Lichen Sclerosus belongs to the family of dermatoses. Other conditions in this diagnostic category which are better known include ezcema, psoriasis, and seborrhea or dandruff. These conditions are chronic meaning they cannot be cured so they must be managed on an on-going basis. Its best to get the condition suppressed then continue a maintainence cream to keep it in check. Another common mistake that even gynecologists make is that they tell patient that it requires a biopsy to confirm the diagnosis. This could not be farther from the truth. The only time a biopsy is necessary is to exclude the possibility for precancer or cancerous transformation. Whenever there is thickening known as leukoplakia then this site warrants biopsy. To learn more about Lichen Sclerosus, contact Fowler Gyn International (FGI). They have developed effective treatment protocols for Lichen Sclerosus which is the result of years of clinical observation and research by the founder, board certified gynecologist, Dr. R. Stuart Fowler. Contact them at http://www.fowlergyninternational.com/contact-us to learn more.

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!