Beyond the Formulary: Helping Clinicians Put Good Clean Rx Into Practice

When we introduced Good Clean Rx, our goal was to give healthcare professionals a broader toolkit for vulvovaginal care: quantitative microbiome testing, vulvovaginal-specific formulation options, and an expanded formulary of compounded prescription therapies within one provider platform.

But access to more treatment options raises an equally important question:

How do clinicians know when to use them?

Many of the conditions we see in vaginal and vulvar medicine are familiar. The therapeutic options available for managing them may be less so.

A clinician may routinely prescribe metronidazole for bacterial vaginosis, fluconazole for candidiasis, vaginal estrogen for genitourinary syndrome of menopause, or clobetasol for lichen sclerosus. But what about a patient with persistent vulvar burning after infection has resolved? When might a clinician consider local gabapentin or low-dose naltrexone? What is the rationale for cromolyn or ketotifen in selected chronic sensitivity presentations? Where might compounded tacrolimus fit into inflammatory vulvar care? And what additional options exist when recurrent or non-albicans Candida does not respond to routine therapy?

These are questions vulvovaginal specialists encounter regularly, but they are not necessarily part of everyday training for every clinician who cares for women.

That is the next problem we want to help solve.

Introducing the IVH Good Clean Rx Clinical Education Series

Over the coming year, the Institute for Vaginal Health will launch a clinical education series designed to help providers better understand the therapeutic options available through Good Clean Rx and, more importantly, the biology and clinical reasoning behind them.

Rather than simply reviewing a list of medications, we will begin with the clinical problem.

Why can vulvar burning persist in the absence of infection? How can neuropathic pain differ from inflammatory or neuroimmune sensitivity? Why is recurrent BV more complicated than the presence of a single organism? Why are some Candida infections harder to treat? What actually changes in vulvovaginal tissue during menopause? And what does it mean to restore the vaginal environment after active treatment is complete?

From there, we can ask the treatment question more intelligently.

More Than Choosing an Active Ingredient

One of the principles behind Good Clean Rx is that local vulvovaginal therapy involves more than choosing a drug.

The clinician must also consider where the biological target is located, what process is being treated, the condition of the tissue, the route of administration, the formulation carrying the medication, and how well that formulation is likely to be tolerated.

A patient with external vestibular neuropathic pain presents a different treatment problem from someone with internal vaginal inflammation. Hormone-depleted tissue requires a different strategy from active BV. And treating an infection is not necessarily the same biological task as supporting the tissue and microbial environment afterward.

Compounding can provide additional flexibility across these variables when a commercially available medication does not fully meet an individual patient's needs. It may allow clinicians to select a different strength or dosage form, use a local route, or combine therapeutic approaches when clinically appropriate.

The value is that compounded medications can expand the clinician's available options.

Exploring the Less Familiar Parts of the Toolkit

The Good Clean Rx formulary includes familiar treatments alongside therapies that many providers may encounter less often in routine practice.

Upcoming IVH education will explore areas including:

• neuropathic vulvovaginal pain and local pain therapies

• mast-cell and neuroimmune approaches to chronic sensitivity

• inflammatory vulvar disease and steroid-sparing treatment

• hormonal and nonhormonal approaches to GSM

• recurrent BV and mixed vaginitis

• recurrent and non-albicans Candida

• vaginal microbiome and tissue recovery

• vaginal health in cancer survivorship

• quantitative microbiome testing

• route and formulation selection

• sexual comfort and arousal

Registered Good Clean Rx providers will receive the clinical education series, where we will go deeper into available therapies, mechanisms, patient-selection considerations, formulation and route, evidence, limitations, and practical clinical use.

This next step will help clinicians understand what the compounded drug options are for, when they may be useful, and how to incorporate them thoughtfully into individualized vulvovaginal care.

Register with Good Clean Rx to access the formulary and receive the clinical education series.