Common Symptoms of External Genitalia Irritation:

The following are a number of real-life symptom scenarios:

It feels inflamed around the opening of vagina and rectum; it’s uncomfortable and sensitive. Has been going on for months and nothing seems to help.

External itching of the lips comes and goes. It’s worse around my period and especially with intercourse when it feels really dry and itchy.

Intermittent irritation around the opening of the vagina that feels hot and itchy and the vagina feels dry ever since starting birth control pills.

Periodic itching around the vagina and can extend into the rectal area. The itching can get to the point it’s hard not to scratch but this causes burning.

The skin outside the opening feels irritated. At times it can get swollen and red, other times it’s just itchy and uncomfortable.                                                                                                   
The external skin fells dry, chaffed, and sticky at times. It can feel like the tissues are tight and being pulled on at times, especially with intercourse.

After shaving down there the skin can get red, sensitive, and feel stippled.

What Causes the Irritation?
For women who have experienced chronic irritation and been to their local healthcare provider and nothing was found… no yeast, eczema, psoriasis, pin worms, scabies, lice, lichen sclerosis, skin cancer, etc…no signs of anything, just sensitive skin, the experts in vaginalhealthCare at FowlerGynInternational believe the likely diagnosis is “vulvar contact dermatitis.” It is caused by exposure to some type of agent or chemical that sensitizes the external genitalia skin. Contact dermatitis generally has no visible findings unless scratching of the tissues has caused some redness or excoriation marks. On occasion there may be slight hazy redness on the skin or the hair follicles may feel slightly raised making the skin feel stippled.

After the condition sets up, external exposure to a host of different products can perpetuate the symptoms even though exposure to the inciting factor may long since be gone. Therefore, the underlying culprit can be elusive and treatment requires attention to everything that comes in contact with the external genitalia tissues. That means everything must be hypocontactant or neutral, non-reactive and non-allergenic. This applies to shampoo, conditioners, detergents, body soaps, body rinses, shaving cream, clothing, toilet paper, female hygiene products, lotions, sexual lubricants, the very micro-organisms allowed to be colonized on the skin itself, and on occasion, the constituents of the vaginal secretions.

The “External Factors”

It’s difficult to avoid all potential contact irritants from multiple sources. It took Dr. Fowler over 25 years and thousands of women-year observations to figure out just the right combination of skin products to help prevent “external factors” sensitization.

The “Internal Factors”

Avoiding the external exposures generally solves the problem. Howlever, on occassion the vaginal secretions can be playing a role. The “internal factors” are the relative concentrations and types of vaginal constituents; in other words, the make-up of the vaginal secretions. If abnormal bacterial concentrations are present in the vagina, known as altered vaginal micro-flora patterns, this can give rise to secretions that bathe the vaginal opening and external genitalia tissues which may result in itching, irritation, and dryness.

The Vaginal Micro-flora

The vagina has a normal micro-flora ecosystem consisting of 30+ co-existing strains of bacteria at any one time. Normally, the good bacteria known as “lactobacillus” dominate and are numerous enough where they coat the entire vaginal mucosal surfaces forming a protective barrier. Problems arise when a shift in bacteria milieu occurs and the “bad” strain proliferate and dominate the “good” strains.

Altered Vaginal Micro-flora Patterns

When the lactobacilli do not thrive, the 30 plus other “bad” bacteria strains proliferate and dominate the micro-flora.  This results in one of several “altered vaginal micro-flora patterns.” In 2007, Dr. Fowler published a landmark study which expanded the known spectrum of altered vaginal flora patterns. Up until then, the medical literature commonly referred to ‘Vaginitis” as consisting of four etiologic types. Dr. Fowler proposed a new Vaginitis Classification System that expands the types of vaginitis to ten types. Reference: Fowler, R.S. Expansion of altered vaginal flora states in vaginitis. J Reprod Med. 2007 Feb;52(2):93-99.  

Symptoms Associated with Altered Vaginal Micro-flora Patterns

The “bad” bacteria that predominate in these patterns consist of a host of aerobic and anaerobic microbes. The resulting vaginal secretions from this shift of bacterial milieu bathe the tissues surrounding the vaginal opening and external genitalia causing variable symptoms including itching, irritation, and sensitivity as well as discharge, odor, burning, urinary urgency/frequency depending on the innate sensitivity of a particular woman’s external genitalia tissues. It follows that the higher the concentration of these bad bacteria, the higher propensity of getting symptoms.

Determining if an Altered Vaginal Micro-Flora Pattern is Present- The VFA Test

If an altered vaginal micro-flora pattern is found, an FGI treatment protocol could prove to be of great benefit for you! The only way to determine whether you have an altered vaginal micro-flora pattern is to perform the Vaginal Fluid Analysis Test (VFT Test). Regardless of where you live, you can arrrange to have this test preformed by the FGI Lab.

In October of 2012, Dr. Fowler published a breakthrough in the understanding of the vaginal micro-flora analysis preformed under phase-contrast microscopy titled, “Quantification of normal vaginal constituents using a new wet prep technique.” He had been using this technique for years for women with vaginal symptoms but for the first time, the relative concentrations and constituents of what constitutes “normal” on wet preparations from women without symptoms became known. This knowledge is essential because these patterns become the therapeutic goal of vaginal therapy. Prior to the findings of this study, it was only inferred by clinical deduction as to what constituted healthy vaginal constituents.  Reference: R.S. Fowler. Quantification of normal vaginal constituents using a new wet prep technique.  J Low Genit Tract Dis. 2012 Oct; 16(4):437-441.

The Bottom Line

The FGI treatment approach uses the hypoallergenic skin care and hygiene products and sometimes topical steroids. If their is no response or limited response after 4 months of treatment, then a VFA Test is recommended. If there is found to be altered vaginal micro-flora, vaginal rejuvenate therapy is added to change the abnormal vaginal micro- flora patterns into one of the normal patterns. The therapy can be monitored to see how effectively the particular therapy is moving the vaginal constituents towards a normal flora pattern while maintaining the external genitalia under strict hypocontactant conditions. This approach has been developed and used by Dr. Fowler with success for the treatment of thousands of women. Are you ready for expert help?

The majority of healthcare providers are unaware of the existence of altered vaginal micro-flora states. Why? To begin with, very few gynecologists specialize in vaginal disorders. Morover, detecting altered vaginal micro-flora patterns requires extra time, training, an advance set of skills and expensive microscopic equipment.  Since there seems to be no incentive in sight for gynecologists to learn advanced microscopic skill, invest in expensive phase-contrast microscopic equipment, and spend the extra time analyzing slides, it is not likely for the VFA Test to be routinely offered in gynecology offices anytime soon!