YOU are not alone. Check out a few real life scenarios:

1. Unrelenting burning pain located at the vaginal opening and on the vulva. It’s exhausting and disheartening. It has ruined a great sex life. It has put real strain on relationships. It easily leads to symptoms of depression. It makes work such as sitting in an office or studying difficult. It makes it difficult to function like a normal person. Does not cause arousal from sleep but after waking up in the morning it kicks off again and burning is back. It can feel like a wound that someone has poured acid on it, at other times just uncomfortable.

2. It’s burning, stinging and rawness at the vaginal opening which makes intercourse painful if not impossible. Other activities that make the symptoms worse can include wearing underwear, tight jeans, sitting on narrow seats such as exercise equipment or soft seats that push up into the area, urine spraying on the skin, wiping after urination and perspiration on the skin.

3. It hurts only during sex; just at the opening, not very deep. Insertion is miserable. It’s unpleasant every time. On penetration it feels sensitive and raw, like an Indian burn. After intercourse it may sting and burn for several hours up to several days. It causes a sense of feeling broken and makes it impossible to have the wonderful sexual experience that is portrayed in the movies.

4. It’s a vaginal burning so intense, it takes control. There may be no way not to think about it. It may difficult to run, play tennis, riding bicycles, or sit for prolonged time periods such as on a plane or in a movie. It puts a damper on intercourse to say the least. It may curtail social activities. It can be difficult to concentrate at work and leads to increased fatigue. Placing an ice pack between the legs to numb it may be the only way to get relief. May have to wearing skirts with no underwear. Being the ideal wife or mother can be out of the question. It’s like living on the verge of a broken relationship, near divorce and possible loss of employment. Lots of doctors don’t recognize the condition. Many medications prescribed without relief including topical lidocaine, Metrogel®, Terazol® cream, estrogen cream as well as oral medications including ampicillin, Diflucan®,Flagyl®, clindamycin, ampicillin, Neurontin®, and Zithromax®.

5. Searing vaginal pain and burning. Unable to sit comfortably, ride a bike, use a tampon, endure a gynecological exam or have healthy sexual relationship without major discomfort. The pain is indescribable.

6. Constant vaginal burning, frequent urination, and discomfort can make it difficult to do most usual activities. In fact, it can be difficult to even enjoy lunch with a friend, when all you can think about is the burning pain in the vaginal area. To describe the pain as “uncomfortable” can be an “understatement.”

7. The pain is located around the vaginal canal opening. It feels as if glass or a hot poker is being pressed into the area. Such things as tight jeans, swimming suits, tights, pantyhose can all make it worse. Intercourse can cause too much contact and exasperate the rawness. It can prevent engaging in intercourse all together. Commonly there is fear of disrupting of the relationship.

8. Like a sharp pain, burning, and inflammation at the vaginal opening. It has a huge impact on lifestyle. It gets so frustrating to be constantly aware of the vagina. Not be able to frequent the lake or swim because wearing a swimsuit is problematic. Padded seats can be particularly bad because they press up against the area. It’s easier to walk with legs apart to reduce friction.

9. The irritation and burning goes all the way from the vagina down to the anus. It can come and go. It often feels like having a shower or tub bath would help but it doesn’t or only for a short time. Pain pills don’t seem to do anything. Not be able to do regular activities and can be hard to get through each work day.

10. There is constant burning by the urethra and occasional slight itching as well. It burns worse on urination. Must blot dry rather than rub after urinating. It makes it difficult to walk very far. Intercourse is impossible.

11. There is vaginal burning and rawness with intercourse or when pants rub across the labia. Feels best to only wear skirts with no underwear or pants at least one size too large. Sitting on workout equipment seats and when the area gets moist with perspiration also makes it worse. The doctors can’t see anything wrong; some suggested just to learn how to live with it, others have inferred it's a mental problem.

Anatomic Location of the Burning Pain:

• At the vaginal opening
• Anatomic location called the vestibule, a circular area of tissue surrounding the vaginal opening
• Also can involve the labia minora or smalll lips

Is There a Name for This Condition of Vaginal Burning?

• It's called vulvodynia.
• Other names include vulvar vestibulitis, provoked vulvodynia, generalized vulvodynia, essential vulvodynia, and dysethetic vulvodynia.

How Bad is This Condition?

• Some women describe the pain as “acid being poured on an open wound” or as “knife-like pain.” 
• Varies in persistence and location
• Can be constant or intermittent, localized or diffuse, spontaneous or happen only when the vulva is touched
• Tends to be a chronic refractory condition lasting for years without proper treatment
• Exacerbated by:
• Sexual activity making it difficult to engage if not impossible
• Wearing tight clothing such as jeans with a midline crease
• Tampon insertion or removal
•  Prolonged pressure or friction applied to vulvar tissues, such as bike riding, horseback riding, or sitting on narrow seats like exercise equipment or soft cushioned seats that push up into the vulvar tissues.
• Vulvar perspiration from exercise or hot weather
• Urine hits the skin, or wiping the tissues after urinating.

How Bad is Bad?

• Pain can be so severe and unremitting it forces women to resign from career positions, abstain completely from sexual relations causing relationship disruption or marital discord, and compromises self-image blunting the zest for life
• Perhaps the worst benign gynecologic condition to experience due of its disruptive impact on lifestyle and relationships
• Perplexing on account that few gynecologists are even familiar with it, let alone how to treat it effectively
• No known therapy that provides acute relief
• Medical literature states most cases are idiopathic, in other words of unknown etiology

How is Vulvodynia Diagnosed?

• A cotton tip applicator test is used to delineate the areas of pain and categorize the severity
• Women often will describe the touch of the cotton applicator as unpleasant to extremely painful
• On account of a normal exam OR AT LEAST WHAT IS EXAMINED FOR… the rest of the story in a moment… many women with this condition have been told that the pain is “in their head”

What do Other Doctors Have to Offer?

• Most gynecologists readily admit that they don’t know how to diagnose and/or threat vulvodynia
• Treatments commonly used include: amitriptyline (Elavil), gabapentin (Neurontin®), topical baclofen, topical amitriptyline, topical lidocaine, cromolyn cream, ketoconazole (Nizoral®) cream or shampoo, Botox injections, corticosteroid injections, interferon, low oxalate diet, ocean water sits baths, baking soda douches, pelvic floor physical therapy, biofeedback, and surgical procedure of vestibulectomy.
• If you have "been there and done that" and remain symptomatic, the good news is that FGI does not endorse any of these modalities as primary therapy. Why? None of them have proven to be of consistent benefit.
• The story of vestibulectomy is more involved. The overall data in the medical literature comes in at 84% response rate. While this initially sounds good, there are disadvantages:
• First, it can only be used in women with the subtype of vulvar vestibulitis
• Second, it’s a surgical procedure that removes the vestibule; a ring of tissue 1-2 cm wide at the opening of the vagina. The vagina is under-minded and advanced down to cover over where the vestibule was removed. Some doctors tell patients that it does not alter the normal female anatomy, but it does.
• Third, there can be post-procedure scarring which can result in pain with intercourse itself
• Forth, the reporting data for most studies is only one year out, a few studies out to 3 years
• Fifth, the most worrisome, women with vulvodynia treated with vestibulectomy can have relapse of vaginal burning after a number of years following their surgery. Dr. Fowler has successfully treated these women as well.

Is There Something Different?

• At Fowler Gyn International, we believe there is a better way; a better evaluation with advanced diagnostic techniques, a better treatment approach.
• At Fowler Gyn International, we have seen and successfully treated hundreds of women with vulvodynia who had often seen multiple previous physicians including a good percentage who had seen other "specialists."

How Common is Vulvodynia?

• An NIH-funded Harvard study, almost 16% of US women suffer from vulvodynia at some point during their lives, with more than 90% reporting ongoing pain for many years.  Approximately six million women currently suffer from vulvodynia.

What Causes Vulvodynia?

• The National Vulvodynia Foundation (nva.org) says “Vulvodynia is not caused by either an active infection or a sexually transmitted disease.  The causes are unknown because of the lack of research on the disorder.”  The etiology has remained an enigma for over a century, BUT has the mystery of vulvodynia finally been unraveled with Dr. Fowler’s research? The response to his  treatment protocols has been impressive, click on “Testimonials” to review.

Expectations for Response

• Vulvodynia tends to be a very refractory and difficult condition to treat. A search of the internet might overwhelm you with fears of hopelessness and discouragement from the stories of countless women who have not gotten relief of their symptoms despite visits with multiple physicians. This was an impetus for FGI to bring their expertise in vaginal healthcare and treatment approach into the digital realm so women like you could locate the experts in the field. The stark reality of vulvodynia is this:

1. Most gynecologists prefer not to see or attempt to manage patients with vulvodynia.
2. There is no quick medical fix.
3. There is no known cream, ointment, or drug which will cause immediate relief, including narcotics. FGI does not advocate pain pills and does not prescribe them. 
4. Despite these difficult set of circumstances, FGI is combing the US looking to help women with this perplexing condition.
5. While FGI cannot guarantee full resolution or the degree of response to recommended treatments which can vary from person to person, treatment progress with vulvodynia is measured in months, not weeks or days. It can take 4-6 months before any therapeutic effect may occur and 8-12 months before progressive and sustained response usually occurs.
6. If there is no response by 4 months or if the response plateaus, an interval follow-up assessment is important.
7. Women with vulvodynia tend to have more sensitive skin than most women and may need to continue some of the treatment recommendations on an ongoing basis or they experience relapse.