Are Primary and Secondary Provoked Vestibulodynia Two Different Entities?

Are Primary and Secondary Provoked Vestibulodynia Two Different Entities? A Comparison of Pain, Psychosocial, and Sexual Characteristics

Leen Aerts MD, PhD; Sophie Bergeron PhD; Serena Corsini-Munt MA; Marc Steben MD; and Myriam Pâquet BA

ONLINE: May 11, 2015 – The Journal of Sexual Medicine

DOI: DOI: 10.1111/jsm.12907            


Vulvodynia - chronic vulvar pain in women - has a prevalence rate of about 8% in the general population, with provoked vestibulodynia (PVD) being the most common cause in premenopausal women.

For women with PVD, pain is localized to the vulvar vestibule and makes sexual intercourse difficult.

Cases of PVD fall into two categories:

Primary PVD (PVD1). Pain has occurred since a woman’s first attempts at vaginal penetration, including tampon insertion.

Secondary PVD (PVD2). Chronic pain has not always been present. Women can remember a time when intercourse was pain-free.

Past research on PVD1 and PVD2 has had conflicting results, perhaps due to small sample sizes and a limited number of examined variables.

The goal of this study was to compare the sexual and psychological aspects of PVD1 and PVD2 in premenopausal women. The researchers also wanted to learn more about the clinical implications of such a comparison.


Participants completed the following questionnaires to provide demographic information as well as data on their medical and gynecological histories, relationships, and sexual experiences:

• McGill-Malzack Pain Questionnaire
• Female Sexual Function Index
• Global Measure of Sexual Satisfaction
• Trait Anxiety Inventory
• Painful Intercourse Self-Efficacy Scale
• Pain Catastrophizing Scale
• Beck Depression Inventory
• Hurlbert Index of Sexual Assertiveness
• Ambivalence over Emotional Expression Questionnaire
• Dyadic Adjustment Scale – Revised
• Experiences in Close Relationships Scale – Revised


Two hundred sixty-nine women between the ages of 19 and 45 participated in the study. Their mean age was 27.1 years. All women were diagnosed with PVD by a gynecologist. Thirty-five percent had PVD1; the remaining 65% had PVD2.

Approximately 22% of the women did not have sexual intercourse. Thirty-six percent of this subgroup named pain as one of the reasons for not doing so.

When the PVD1 and PVD2 groups were compared, researchers found no significant differences in pain, sexual functioning, sexual satisfaction, psychological factors, and relationship factors.

However, on average, both groups scored in the clinical range for sexual dysfunction and impaired psychological functioning.


Women with PVD1 tended to be younger than those with PVD2, most likely because they had been experiencing PVD from their first vaginal penetration. The authors suggested that because women with PVD1 started having pain at such a young age, they might become “insecure” and not pursue sexual relationships.

Women with PVD1 also tended to have pain for a longer period of time compared to the women with PVD2. Again, this could be the result of the early age these women started experiencing PVD1.

Assessments of depression, trait anxiety, pain self-efficacy, catastrophizing, and dyadic adjustment were similar for women in both groups. This finding is in contrast to past studies on PVD subtypes.

The two groups of women were also similar in terms of behavioral avoidance of vaginal penetration, sexual assertiveness, ambivalence over emotional expression, and romantic attachment. “This suggests that although women with PVD1 and PVD2 may differ in terms of their biomedical characteristics, and possibly etiology, they nevertheless present similar psychosocial profiles,” the authors wrote.

Both groups scored below the clinical cutoff point for sexual dysfunction. While there were no differences in types of psychological impairment, women in both groups did have some degree of clinical psychological distress.

The researchers acknowledged several limitations:

• Only premenopausal women younger than age 45 were included, so results cannot be generalized to all women with PVD.
• Factors such as sexual abuse, physical abuse, and hormonal contraceptives were not considered.
• The questionnaires were self-report measures, so social desirability bias could be present.

Women with both types of PVD could benefit from similar psychosocial and sex therapy interventions, the authors noted. “Therefore, clinicians should be sensitive to the sexual and psychosocial needs of women with PVD, regardless of subtype, through provision of accurate education and psychosexual support,” they added.