Vulvodynia causes burning, stinging, rawness or just flat out pain  at the vaginal opening. Over the last 150 years, treatments that have been proposed have been based on the theory it’s a problem of the genital skin and nerves. Dr. Fowler discovered that the stimulation of the skin and nerves is secondary to the underlying etiology. Moreover, the Fowler Gyn Approach does not use the common treatments that have been popularized because none of these have resulted in consistent sustained success. These include use of tricyclic antidepressants like Elavil® (amitriptylline), Pamelor® (nortriptyline), Norpramin® (desipramine), or Tofranil® (imipramine), aminoketone class of antidepressant Wellbutrin® (bupropion hydrochloride), selective serotonin and norepinephrine reuptake inhibitor (SNRI) serotonin-norepinephrine reuptake inhibitors such as venlafaxine, or Cymbalta® (duloxetine),  topical 2-5% lidocaine, anticonvulsants such as Neurontin® (gabapentin), neuroactive drug Lyrica® (pregabalin), GABA agonists such as baclofen, antihistamines such as hydroxline, synthetic cannabinoid Cesamet® (nabilone), opioid pain medication Ultram® (tramadol), botox injections, valium vaginal suppositories, vaginal atropine/cromolyn cream, vaginal valium/baclofen/ketamine suppositories, vaginal amitryptyline/baclofen/gabapentin gel, vaginal dilute hydrogen peroxide in gel, topical external genital estrogen/testosterone, Capsaicin cream (the stuff in chili peppers that makes your mouth feel hot when eaten), opioid narcotics, oat meal or salt sitz baths, Nizoral® 2% ketoconazole Shampoo applied to external genitalia, aquaphor, oxalate or other diets, physical therapy for pelvic floor dysfunction, biofeedback, acupuncture, nerve blocks, surgical excision by vestibulectomy with vaginal mucosal advancement, or thermo-ablative fractional CO2 laser treatments such as MonaLisa Touch®, CO2 RE Intima®, and Genevieve®. While some of these modalities work great for one or another symptom, few if any have a sustained effect lasting beyond a year or more for vulvodynia. Some women spend months trying to figure out what all the options are; well there they are!  Go ahead, give them all a try if you wish, then come back and proceed with the Fowler Gyn Approach when you really want to get fixed.