The primary aim of this study is to determine the efficacy of milnacipran in reducing pain in
women with provoked vestibulodynia (PVD), a centrally mediated pain syndrome similar to
fibromyalgia, that is characterized by severe pain in the vestibule (outer vagina). The
investigators will also determine whether associated symptoms in PVD, including psychological
distress, impairment of sexual function, physical function, and quality of life, are
correlated with a reduction in vulvar pain.