We are indebted to Harvard Vanguard Medical Associates (HVMA) and Atrius Health Foundation for their belief in the need for improved health care for women suffering from vulvovaginal disorders. From 1992 to the present, HVMA has supported the Vulvovaginal Service, open to patients with these problems five days a week.
All four of us authors, in the course of practicing Ob Gyn or Dermatology, saw patients with problems we could not solve, dyspareunia, pain, or intractable itching we could not fix, and other conditions we could not diagnosis or treat. Without much in the way of evidence in the literature, we learned what we could, apprenticing with those who knew more than we did, each becoming committed to not giving up on the women who had shuttled from clinician to clinician trying to find answers and relief.
In 1998, Dr. Margesson co-authored her book Genital Dermatology (it became the Atlas in the website). In 2002, Dr. Stewart published her landmark book, The V Book, a doctor’s guide to complete vulvovaginal health, written for women, but even now a “closet resource” for women’s health clinicians throughout the world.
We gained some valuable experience and successes in helping women, who told us, “you didn’t just help me, you saved my life!” We became determined to share what we had learned, to fill in the blanks for practitioners in the insufficient vulvovaginal medical educational system.
We conceived the idea of a medical algorithm which would specify the steps we took in clinical practice. That algorithm expanded, over the years, into the website you see here. It is still a work in progress, but its electronic format provides the capacity for ongoing improvement and updating, as medical evidence evolves.
We are not internet gurus; we are not marketing experts. We have not had the backing of large foundations or commercial sponsors. We are clinicians with a passion to improve women’s suffering through medical education.
Early funding for this idea and this website came from the administrators and employees of HVMA, the Board of Atrius Health Foundation, and from the generous donations of patients and their families. In the later stages of its development, in order to complete the material as best we could, two of us have put in thousands of hours of our own time and funded the project out of our own pockets.
We welcome you to our labor of hope. We ask for your patience as we continue to improve and update the information. We anticipate that, once empowered by this information, you will become impassioned, as well, about bringing vulvovaginal disorders out of the dark, believing what women tell you, and knowing how to help.
Elizabeth Gunther Stewart, M.D., FACOG
Elizabeth Gunther Stewart, M.D., FACOG, is co-founder and Director Emerita of the Vulvovaginal Service at Harvard Vanguard Medical Associates in Boston. Dr. Stewart is also Assistant Professor of Obstetrics and Gynecology at Harvard Medical School and a member of the Beth Israel Deaconess Medical Center staff. She is a Fellow of the International Society for the Study of Vulvovaginal Disease and of the American College of Obstetricians and Gynecologists. She is on the Board of Directors for the National Vulvodynia Association.
Dr. Stewart graduated from the George Washington University School of Medicine in 1981 and completed a residency in Obstetrics and Gynecology at Beth Israel Deaconess Medical Center in 1985.
She is the author of The V Book, A Doctor’s Guide to Complete Vulvovaginal Health, and was the co-investigator in the National Institutes of Health funded first epidemiological study of vulvovaginal pain. The study findings (Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? JAMWA 2003; 58:82-88) showed that vulvovaginal pain of more than three months duration is found in 16% of ethnically diverse women.
Ione Bissonnette, CNM, MSN
Ione Bissonnette, CNM, MSN, met Dr Elizabeth G. Stewart and Diana Parks-Forbes, NP, while practicing as a full-scope nurse-midwife at Harvard Vanguard Medical Associates and Brigham and Women’s Hospital in 1995. Impressed by their ability to diagnose and treat women with vulvovaginal complaints, she became an apprentice to Dr Stewart over the course of a year and then attended the ISSVD (International Society for the Study of Vulvovaginal Disease) postgraduate course in Salvador, Brazil in 2003. While continuing her midwifery practice, she joined the Vulvovaginal Service at Harvard Vanguard in 2004.
In 2005, she became the first Advanced Practice Clinician Fellow of the ISSVD. She is a member of the National Vulvodynia Association and the American College of Nurse Midwives, as well as the ISSVD.
Ione graduated from Columbia University in 1975 with a BS in Nursing and received a Master’s Degree in Midwifery from the University of Pennsylvania in 1987.
She has lectured on vulvar lichen sclerosus (2005), vaginal microscopy, pH and KOH in vulvovaginal care (2006), vulvar dermatoses (2008), vestibulodynia (2009), vulvovaginal diagnosis and treatment, (2009), vaginal atrophy (2012), and bacterial vaginosis (2012). She and Dr Stewart have initiated teaching sessions at Beth Israel Deaconess Medical Center’s Ob Gyn Residency Program (affiliated with Harvard Medical School) to help integrate this website into the knowledge base of residents and medical students. (2015-16).
In 2013, our presentation of this website at the ISSVD World Congress won a best paper award and the website was subsequently formally endorsed by that organization.
Lynette J. Margesson, MD
Lynette J. Margesson, MD, practices with her dermatologist husband in a private dermatology practice in Manchester, New Hampshire. She also works on a monthly basis with gynecologist Dr Debra Birenbaum in a vulvar clinic at the Dartmouth-Hitchcock Medical Center, seeing patients and teaching residents in Dermatology and Gynecology. She has been with Harvard Vanguard Medical Associates since 1998, consulting on complex vulvovaginal cases with Dr. Elizabeth Stewart and Dr. Cynthia Rasmussen.
She received her medical degree from the University of Western Ontario, Canada in 1970, and completed her dermatology training at the University of Toronto in 1975, at which time she received her specialty certificate as a Fellow of the Royal College of Physicians of Canada (FRCPC).
She became a Diplomate of the American Academy of Dermatology in 1976 and is Assistant Professor of Obstetrics, Gynecology, and Surgery (Dermatology) at the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.
She is the co-author of two textbooks on vulvar disease, Genital Dermatology, written with Benjamin Fisher, MD in 1998, and Obstetric and Gynecologic Dermatology, written with Martin M Black and Marilynne McKay, et al in 2002. She is an active member of the International Society for the Study of Vulvar Disease (ISSVD) and lectures on vulvar disease nationally and internationally. Most of the material in the Atlas of Vulvar Disorders in this website was contributed by Dr Margesson.
Diana Parks Forbes, NP
Diana Parks Forbes, NP, was the co-founder of the Vulvovaginal Service in 1992, and has been helping women with vulvovaginal disease for over 25 years.
She obtained a nursing diploma in 1968, then a BSN at Northern Illinois University 1970. She became a certified nurse practitioner in adult care 1976 at Brigham and Women’s Hospital and obtained a MSN from Boston University in 1977. She worked in private practice, and then joined Harvard Vanguard Medical Associates in 1980. She became certified in Women’s Health in 1981.
In the Harvard Vanguard practice, she developed expertise in human sexuality and vulvar disease in children. She has lectured on both those subjects, as well as other topics in vulvovaginal diagnosis and treatment. She now lives in Western Massachusetts and works in a private gynecology practice nearby.