It does matter where you live in terms of what resources there are available to you. I was able to use a cream for also a year that my gyn had prescribed before I found a clinic where I begin injections three months ago. No letters necc, tho', I have been seeing my therapist just after I started with the cream. I will need letters for lower surgery that I want to have later this year. Sorry, you've been in this run around for so many years.