By Riva Preil The diagnostic features of VBD include extreme pain upon attempted vaginal penetration, vestibular pain when touched with a cotton swab, and erythema (redness) in the vestibule. These are called Freidrichâ€™s criteria. Treatment includes tricyclic medications (ex. amitriptyline) to alleviate pain, especially in cases of secondary VBD. Also, antiseizure medications (ex. carbamazepine) and anticonvulsant drugs (ex. gabapentin) have been used to help women with VBD. One should speak with their physician regarding medications and the possible side effects if they think they may benefit from this form of treatment. Furthermore, physical therapy is a crucial component in treating VBD. The pain which results from VBD can be viewed as a stressor or assault to the pelvic floor muscles. In response to pain, the muscles in the pelvic floor can tighten and may even spasm as a protective mechanism to prevent further injury. However, the tightening of the muscles themselves can cause a cascade of problems including formation of trigger points, decreased muscle flexibility, skeletal misalignments, and additional nerve compression. Therefore, women with VBD should participate in physical therapy to help treat the secondary musculoskeletal dysfunctions. Vestibulectomy, a surgical procedure performed to remove the irritated and vestibular tissue along with the inflamed nerve endings, should be used as a last resort and only if all the treatments have failed. The hesitancy surrounding this surgery is due to the fact that nerves tend to have better memories than we want them to have- the brain may still continue to perceive pain even from a severed nerve! (This is similar to the concept of phantom limb pain, and this is the reason why individuals may continue to feel the presence of a limb even after it has been amputated.) Therefore, since the initial success rate of vestibulectomy is only 60% (approximately), it should be reserved for individuals who are completely unable to participate in intercourse due to pain (if medication and physical therapy were unsuccessful). Fortunately, this procedure should not impair areas associated with sexual pleasure, and it has not been shown to interfere with fertility, pregnancy, and delivery.