Vulvovaginal Issues: About Diagnosis and Treatment

Women with intimate issues are often hesitant to seek help as they are uncomfortable discussing these concerns with their doctor. Unfortunately, few gynecologists specialize in vulvovaginal issues, because of this, it can be challenging to get an accurate diagnosis and successful treatment.

Vulvovaginal Issues: About Diagnosis and Treatment

Vulvovaginal Issues

Many vulvovaginal issues are caused by vaginal dysbiosis, which is an imbalance in the bacterium in the vaginal microflora. These conditions include vulvodynia, recurrent bladder infection, chronic bacterial infection,  and chronic vaginal discharge,

The vaginal microflora consists of different types of bacteria but is dominated by ‘good’ bacteria known as lactobacilli. Lactobacilli produce lactic acid and hydrogen peroxide that keep the pH of the vagina relatively low. This combination inhibits the growth of pathogens and keeps the vagina free of infection. 

An imbalance occurs when there is a change in the bacterial milieu, leading to the multiplication of ‘bad’ bacteria that dominates the ‘good’ bacteria. 

When the vagina is dominated by harmful bacteria, the vaginal secretions become caustic. The secretions can irritate the tissues inside the opening of the vagina and trigger a range of symptoms, including burning, itching, odor, abnormal discharge, urinary urgency, and/or urinary frequency.   


An imbalance in the vaginal microflora is also known as an altered microflora pattern. An altered microflora pattern differs from the known patterns of flora. 

A vaginal fluid analysis (VFA) test can be used to diagnose vulvovaginal issues caused by an altered vaginal microflora.

The VFA test was developed by vulvovaginal specialist Dr. R. Stuart Fowler of Fowler GYN International (FGI).  FGI carries out the analysis of the vaginal constituents at its CLIA approved lab.

The VFA test is an advanced diagnostic tool that evaluates the constituents of the vaginal secretions to determine if the vagina is in a healthy or altered state. The test identifies the relative concentrations of the various vaginal constituents, namely, squamous cells, lactobacilli, non-lactobacilli bacteria, white blood cells, and yeast.


If an altered vaginal microflora pattern is detected, FGI uses vaginal rejuvenate therapy to restore the vagina to a normal state. This is a customized treatment protocol that combines medications and hypocontactant skincare products. 

The medications prescribed in the treatment protocol depend on the specific information provided by the VFA test. FGI recommends that women with vulvovaginal issues use hypocontactant skincare products, since they usually have sensitive external genital tissues.

Vaginal rejuvenate therapy treats the underlying cause of the vaginal symptoms and shifts the vaginal microflora towards normal. 

The FGI team monitors the progress of vaginal rejuvenate therapy to determine the effectiveness of the medications prescribed. The treatment plan is adjusted as needed to ensure that the vaginal ecosystem is responding as anticipated.


It typically takes 4-8 months for patients to experience a significant improvement in symptoms. Therefore, they need to be committed to the treatment protocol and not expect instant results. It can sometimes take up to 12 months for the symptoms to resolve.

Some providers are not aware of the underlying etiology of complex vulvovaginal issues. That’s the reason why women may not get the treatment they need despite visits to various providers, so they often have to live with their symptoms for a long time. However, when you consult with Dr. Fowler at FGI, you will get a comprehensive diagnosis and an effective treatment protocol.

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