When women were asked would they rather have a happy marriage or lose 10 pounds, they chose the weight loss. This might apply. Clinically I understand the diagnosis is based on minute erythematous dots in the vestibule, associated with pain with Qtip pressure. Dr. Fishers column in Cutis this month is about the perplexing problem of men who can't tolerate their pants. Elavil was not listed as therapies attempted, nor was surgical excision of their thighs.
Topical doxepin is absorbed too much and ends up being sedating.
It also occasionally behaves as a severe irritant. Not rinsing it leaves a thin soothing layer of it on raw tender skin. For daily cleansing plain Aquanil is great - less irritating than water when tested on diaper dermatitis. Irwin, you might consider a consultation with a neurologist for a TCA, sometimes used in a variety of chronic pain syndromes. I recently had a similar patient who was helped tremendously by this.