The V Book came out in July 2002, and has now gone into its second printing. Rights have also bee sold in the United Kingdom and in China.

Since The V Book went to press, new developments have occurred. Here is one exciting new study on the use of tricyclic antidepressants for chronic vulvar pain. Last summer, the National Institute of Child Health and Human Development committed to funding this long-awaited clinical trial starting at the University of Rochester Medical Center under the direction of Dr. David Foster, who has extensive experience in research and treatment of vulvar vestibulitis.

The study will conduct a randomized, placebo-controlled, double-blinded clinical trial to study the clinical efficacy of four medical regimens: a topical anesthetic (lidocaine) alone, an oral tricyclic antidepressant (desipramine) alone, topical lidocaine combined with oral desipramine, and sugar pills (placebo) alone or combined with an inactive topical.

Although the precise mechanism of action remains undefined for tricyclic antidepresssants, a central action through the brain and spinal cord is suggested. The topical anesthetic acts locally on nerve endings in the vestibule.

Lidocaine has long been prescribed by clinicians for relief of the symptoms of vulvar vestibulitis. Now it will be used as a treatment, applied 5-6 times daily. The tricyclics have been used for some time in the treatment of vulvar pain, but often not in the doses planned for the study 200-250 mg daily.

Dr.Foster will also be looking at vestibular tissue samples to determine the relationship between genetic factors, inflammatory substances (cytokines) and response to treatment.

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