Symptoms and signs of patients with focal vulvodynia or vulvo-vestibulitis syndrome (VVS) are variable in location and severity. It is not known whether the location of the most severe pain in the vestibulum is linked to the complaints and perhaps a different entity. A clinical gut feeling suggests that two distinct varieties of focal vulvodynia may be either focused at 2 points (5 and 7 o' clock) or at 4 points (5, 7, 1 and 11 o' clock). A questionnaire was filled out by 30 women with focal vulvodynia during 147 visits and checked for completeness by an independent study nurse. Another investigator to evaluated the clinical signs of VVS, blinded to the patients history or complaints. The visual analogue score (VAS) of pain experienced upon attempt of sexual contact was used as a marker of severity. Focal vulvar pain was assessed using Q-tip with a score from 1 to 10 on 7 areas of the vestibulum. Besides pain during sexual contact, 47% also had pain on inserting a tampon. More than 40% of women suffer since more than 3 years, 70% had to interrupt the act of sexual intercourse mostly or always due to unbearable pain and 25% never had satisfactory sex due to this pain. Feeling deep pain, burning lasting for 12-24h after sexual contact, and stopping the attempt of intercourse were more prominent in women with high pain scores (VAS): 26% of women with VAS>7 had no sex during the last year versus 6% in the group with low pain score (p=0.004). Patients suffering from para-urethral pain zones at 1 and 11 o' clock, have more often pain upon deep penetration, and experienced more pain when inserting tampons than patients with only painful areas at 5 and 7 o' clock (p=0.001). We conclude that patients with severe disease display a different panel of complaints than women with less pain. Patients with focal pain at 1 and 11 o' clock have more deep pain sensations, but feel less pain during insertion of tampons. Hence disease with bi-focal disease may have a different ethiopathogenesis that 4-focal disease. Glands of Bartholin and Skene may be involved in this pathogenenis.