Fowler Gyn International

The Experts in Vaginal Health Care

Paradise Valley
Medical Plaza

5410 N. Scottsdale Rd

Suite B-200

Paradise Valley, AZ 85253



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Diagnostics: The VFA Test

The New Revolutionary VFA Wet Prep Test

The new revolutionary VFA Wet Prep Test (VFA Test) developed by Dr. R. Stuart Fowler, formerly of the Mayo Clinic from 1992 to 2013, provides the quantitative analysis of the vaginal fluid constituents; providing more information than conventional “wet preps.” The century old technique of wet preparations has been used by medical practitioners for decades to determine whether one of four types of vaginitis is present. The advanced Vaginal Fluid Analysis technique expands the classification to ten types including a spectrum of Altered Vaginal Micro-flora Patterns. This represents a breakthrough in understanding aberrant vaginal constituent parameters that can manifest. Treatment can now be directed towards correcting them and getting you on the path to relief of your vaginal symptoms. The specific features of the test have been published by Dr. Fowler in the respected peer-reviewed Journal of Lower Genital Tract Disease, October Issue 2012;16(4):437-441.

The VFA Test reveals the following vaginal constituents: 1) the degree of maturation of the squamous cells, 2) the relative concentration of squamous cells present, 3) the presence and concentration of lactobacilli- the “good” bacteria, 4) the presence, type, and concentration of any white blood cells, 5) whether excessive non-lactobacilli bacteria, the “bad” bacteria are evident as clumps in background fluid or speckling on squamous cells , and 6) the presence and relative concentration of yeast in terms of either blastospores and/or pseudohyphae present.

The Details and Significance 

1. The maturation stage of your vaginal squamous cells

The squamous cells are the normal vaginal mucosal cells lining the vagina and cervix. Some women are fearful when they hear the word “squamous cell” because many skin cancers start from this cell line and are called “squamous cell cancers.” However, squamous cells in and of themselves are normal. Fully maturated squamous cells are loaded with glycogen which provides nutrient for the “good” bacterial in the vagina known as lactobacilli. The VFA test reveals whether the majority of them are fully maturated cells, intermediate cells, or atrophic being parabasal or basal cells. If the majority of cells are not fully maturated, this suggests that 1) the vaginal mucosa is not getting enough nutrient or 2) the vaginal mucosa receptors are not responding to the natural nutrients in the circulation or to the type, frequency or dosage being supplemented. In this case, treatment directed to increase the squamous cell maturation needs to be considered. 3) and/or there is a process going on increasing the exfoliation of cells as per #2.  

2. The concentration of squamous cells present.

This parameter reflects how fast the squamous cells are being exfoliated from the vaginal mucosal surface. This represents a second measure of proper maturation AND the degree of stimulus or irritation present on the vaginal mucosa causing premature exfoliation of the vaginal lining squamous cells. In this case, consideration for treatment with certain types of vaginal products to reduce vaginal irritation or inflammation can be necessary.

3. The presence and concentration of lactobacilli.

These are the “good” bacteria of the vaginal. In reproductive age women they are present in concentrations that literally coat the entire vaginal mucosal surface. Between the barrier effect and the secretion of hydrogen peroxide and other peroxidases, lactobacilli prohibit the proliferation of other bacteria and yeast in the vagina.  If the lactobacilli counts are low, there is risk of developing altered vaginal flora patterns where the other 30+ bacterial which are normally in the vagina at very low concentrations, proliferate and take over. In this setting, vaginal therapy directed at correcting the nutrient supply for lactobacilli is warranted. 

4. The type and concentration of white blood cells (wbc’s).

The types of WBC’s fall into two categories: 1. Agranulocytes which consist of lymphocytes, monocytes, and macrophages. 2. Granulocytes which consist of neutrophils that subdivided into toxic vs. non-toxic appearing, basophils and eosinophils.  Eight-two percent of healthy vaginal flora patterns show the absence of white cells. Fourteen percent of women with WBC’s in their vaginal fluids, have predominately lymphocytes in relatively low concentrations and good concentrations of lactobacilli, the “healthy” vaginal bacteria. All other “normal women” i.e. without vaginal symptoms have no WBC’s present. If you are found to have WBC’s present in your vaginal fluids, the type and concentration determine whether you have Inflammatory Vaginitis (IV) or Desquamative Inflammatory Vaginitis (DIV). The WBC’s last for 3-4 days and then decompose releasing their contents that can irritate the vaginal mucosa. This situation calls for treatment directed to reduce vaginal inflammation. It tends to require longer treatment for effect when the WBC’s are Granulocytes rather than Agranulocytes.

5. The relative concentration of non-lactobacilli bacteria present.

Excess non-lactobacilli bacteria manifest as clumps of bacteria speckling the cytoplasm of the squamous cells or by the presence of streaming bacteria in the background fluids. When lactobacillus counts are low, these 30+ other bacteria that are normally in the vagina at low concentrations proliferate and can become the dominant strains. 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 really needed is to correct the underlying reason for the shift in altered vaginal micro-flora. 

6. The presence or absence of yeast.

When lactobacilli counts are low and the other 30+ bacteria proliferate it does set up a micro-environment culture media that allows yeast to grow more readily. Also when the vaginal mucosa is only partially estrogenized, it’s a better culture media for yeast species to thrive. To solve the recurrent yeast problem, the underlying condition of the vagina reflected by the above parameters evaluated in the VFA test need to be optimized. If yeast is identified then it is helpful to identify the strain of the yeast to determine the length and type of anti-yeast treatment required while ongoing therapy is directed to the vaginal mucosa. The “standard” vaginal yeast strain is called Candida albicans. This responds to most antifungals. The non-albican strains include C. galbrata, C. tropicalis, C. krusei, C. parapsilosis, C. pseudotropicalis/ kefyr, etc. do not respond to the standard antifungals known as imidazoles but require triazoles. The strain identification is not included in the VFA Test therefore if the VHF Test shows yeast then proceeding with a Yeast Strain Test might be recommended. Treating the yeast alone will only give a transient response at best. Treatment needs to be directed at fixing the underlying vaginal mucosal condition.

So there you have it…that’s the basis of the VFA Test. The actual testing requires a phase-contrast microscope with high power objectives; by no means standard equipment for today’s gynecologic offices. FGI makes this advanced diagnostic test available to you: the question is, Are you ready for expert help?

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