| Treatment |
Purpose |
Start Dosage |
Continued Dosage |
Side Effects |
Precautions |
| Oral Therapies |
| Amitriptyline (Elavil) tricyclic antidepressant |
Reduces tissue sensitivity |
25mg at night for 10 days then 50mg a day. |
50-100 mg (higher doses up to 225 mg are occasionally successful) |
Fatigue and dry mouth (common); weight gain and constipation (less common). |
Older patients should be started on lower doses. |
| Calcium citrate |
To reduce oxalate levels in the tissues |
2 tablets twice a day. |
2-4 tablets twice a day. |
Very little. |
Generally combined with other treatments. |
| Desipramine (Norpramin) antidepressant. |
Decreases tissue sensitivity. |
25mg at night for 10 days then 50mg a day. |
50-100 mg (higher doses up to 225 mg are occasionally successful) |
Same as Elavil, but less frequently. |
Older patients should be started on lower doses. |
| Gabapentin (Neurontin) traditionally used to treat seizures and nerve pain caused by herpes. |
Decreases tissue sensitivity. |
300mg a day, increasing every 5 days by another 300mg (to dosing 3 times a day) |
300mg x3 times daily up to a maximum of 900mgx3 times daily (total, 2,700mg) |
Fatigue, nausea, vomiting, dizziness (usually passes quickly and is mild) |
|
| Paroxetine (Paxil) antidepressant. |
Decreases tissue hypersensitivity. |
10mg once a day. |
20-60mg once a day. |
Weight gain and fatigue, but rarely. |
Medication should be stopped gradually. |
| Venlafaxine (Effexor) used to treat major depression. |
Decreases tissue hypersensitivity. |
37.5mg a day. |
75 to 150 mg a day. |
Digestive problems, anxiety. |
Your blood pressure, cholesterol and electrolyte levels need to be checked regularly. |
|
|
| Diet Therapy |
| Low Oxalate Diet |
Reduces oxalate levels in the vulva tissue. |
Avoidance of a list of certain high oxalate containing foods (list below) |
|
|
It should only be continued if a clear benefit is noted. The role of oxalates in vulvodynia is still controversial. |
| Surgery |
| Perineoplasty - also called vestibulectomy |
Surgical removal of most sensitive part of the vulva tissue. |
|
|
Healing can be slow, although the procedure is usually successful. |
Only useful if pain is limited to a specific part of the vulva (vulvar vestibulitis). Surgery is usually a treatment of last resort. |
| Topical Therapies |
| Lidocaine gel or cream (5 percent) such as Lidamantle or Xylocaine |
Acts like a local anesthetic to reduce hypersensitivity |
Apply it to the affected area. |
As needed before intercourse or nightly on a cotton ball placed inside the vagina. |
|
|
| Cromolyn cream (4 percent) |
Helps reduce local inflammation. |
Apply 3 times a day. |
Continue 3 times a day. |
|
|
| Alternative Therapies |
| Biofeedback training |
Improves control over muscles in the vulva area. |
After evaluation by a biofeedback therapist you will be given exercises to practice daily at home. |
Continue exercises for 16 weeks. You will need between 6 and 16 sessions with your therapist. |
May be some discomfort. |
You will need a biofeedback home electromyographic monitor. |
| Cognitive behavioral therapy |
Increases the patient's understanding of their condition and encourages them to find ways to minimize symptoms. |
8 x 2 hour group sessions over 12 weeks. |
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|
May need therapy for up to 18 months. |
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