Why is lichen sclerosus so commonly missed?

Lichen sclerosus is frequently missed because many clinicians are not examining the vulva properly — or at all. Physicians trained in standard residency programs were often taught not to examine the clitoris, leaving vulvar conditions undetected during routine exams. Without a thorough visual and physical assessment of the entire vulva, lichen sclerosus can go undiagnosed for years while symptoms are attributed to other causes.

Why does recurrent BV keep coming back?

Recurrent bacterial vaginosis often persists because treatment is not individualized to each person's vaginal microbiome. There is no one-size-fits-all approach — what resolves BV in one patient may not work for another. Additionally, some diagnostic tests used for BV, including certain DNA tests that only check for Gardnerella, can produce false positives and lead to overtreatment that disrupts the microbiome further.

Are DNA tests for BV accurate?

Not always. Some DNA tests used for bacterial vaginosis only check for Gardnerella, which is present in many healthy vaginal microbiomes. Relying on these tests can result in false positives and overtreatment. A more complete picture of vaginal microbiome health requires broader testing and clinical evaluation beyond a single organism marker.

Is one-dose Monistat safe for yeast infections?

One-dose Monistat is not recommended by some vulvovaginal specialists because it can cause severe inflammatory reactions in the vulva. Multi-day formulations are generally better tolerated. Women experiencing recurrent yeast infections or unusual reactions to over-the-counter treatments should see a clinician with specialized vulvovaginal health training rather than continuing to self-treat.

Why does anatomical language matter in women's healthcare?

Teaching women accurate anatomical language — understanding the difference between the vulva and the vagina, labia minora and labia majora — improves clinical outcomes. When patients can describe symptoms with precision, providers are better equipped to identify what is actually wrong. Imprecise language contributes to missed diagnoses and delays in appropriate treatment.

What is desquamative inflammatory vaginitis?

Desquamative inflammatory vaginitis (DIV) is a chronic inflammatory condition of the vagina that causes significant discharge, irritation, and pain. It does not always show up on standard swab testing and often requires microscopic examination of vaginal secretions for accurate diagnosis. DIV is frequently misdiagnosed as a yeast infection or BV, leading to years of ineffective treatment.

Teaching Anatomical Language, AI in Medicine, and Why Three OB-GYNs Stopped Delivering Babies with Dr. Meredith McClure and Dr. Ashley Fuller

May 15

Written By Sameena Rahman, MD, FACOG, IF, MSCP

Dr. Meredith McClure and Dr. Ashley Fuller co-host the Labialogic podcast, run gynecology-only practices in Dallas and Seattle respectively, and specialize in the conditions most doctors either miss entirely or send home with a shrug — lichen sclerosus, desquamative inflammatory vaginitis, recurrent BV and yeast that won't quit. The three of us have a lot in common, including the fact that we were all trained in residency not to examine the clitoris. That's not a typo.

One of the worst gaslighting stories we share in this episode: a patient with PGAD — persistent genital arousal disorder, a condition that causes unrelenting, unwanted genital sensation — was told by a provider, "You've been through childbirth. How bad could this be?" That's the bar we're working against.

We get into why recurrent BV has no universal solution and why the DNA tests a lot of doctors are leaning on for diagnosis only check for Gardnerella — which means false positives, overtreatment, and a microbiome that keeps getting more disrupted with every round of antibiotics. We talk about why one-dose Monistat can cause severe vulvar inflammation and should not be the default recommendation. We discuss the vaginal inflammation that doesn't show up on a swab and requires an actual microscope to diagnose — a tool that is apparently controversial to use in 2026. And we get into why teaching patients the difference between vulva and vagina, labia minora and labia majora, is not just semantics. It is a clinical intervention that changes what gets diagnosed and how fast.

We also talk about AI in medicine, why private equity entering women's healthcare is a problem worth paying attention to, and what it actually took for three OB-GYNs to walk away from delivering babies and build practices around the work nobody else wanted to do.

Topics covered in this episode:

Why residency training left all three of us unprepared to examine and diagnose vulvar conditions
Lichen sclerosus: the most commonly missed vulvar diagnosis and why it keeps getting missed
Recurrent BV and why one-size-fits-all treatment doesn't work
BV DNA tests that only check for Gardnerella — and the false positives driving overtreatment
Why one-dose Monistat can cause severe inflammatory reactions in the vulva
Desquamative inflammatory vaginitis and why it requires a microscope to diagnose
Teaching anatomical language as a clinical tool that actually improves outcomes
Medical gaslighting in vulvovaginal care — including what was said to a PGAD patient
AI in medicine and why private equity is a problem for women's healthcare

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Every episode of Gyno Girl Presents is a conversation I wish more women could have with their doctors — without the 10-minute clock running. Subscribe wherever you listen, and if this episode helped you, share it with a woman who needs to hear it.

Lichen SclerosusRecurrent BVVulvovaginal HealthWomen's HealthMedical GaslightingVulvar AnatomyVaginal InfectionsAnatomical LanguageDesquamative Inflammatory VaginitisWomen's Sexual HealthPelvic HealthGynecology

Sameena Rahman, MD, FACOG, IF, MSCP

Dr. Sameena Rahman is a board-certified OB/GYN and founder of The GSM Collective in Chicago. She specializes in sexual medicine, menopause care, and complex gynecology, offering personalized, concierge-level care through an integrative lens.

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