@biancasmythe Thank you for your honesty. And I'm thankful to hear if I'm interpreting correctly, anger and frustration that no one really understands EMPD vulva and no Moh surgeon has experience with surgery on the vulva. I asked the dermatologist who might have done the massive surgery taking skin from my thighs - what if he nicked my bladder or urethra. He said, though he as really nice, I could have a bag for urine. (probably not his terminology). I'm 77 1/2. I am angry and frustrated, and afraid that taking the route of no surgery, at least for now, is going to leave me without support medically. It's all so unknown. No surgery, I've done 10+ years unknowingly. The itch and burn is sometimes horrible, but not unbearable. Will it turn to cancer? Will it go from non-invasive to invasive? But with surgery, how long before it returned and the rest of my life going from surgery to surgery and not living in some ways. It's one day at a time and living as fully as I can.