Primary and Secondary Provoked Vestibulodynia: A Review of Overlapping and Distinct Factors.

INTRODUCTION: A common subtype of vulvodynia is provoked vestibulodynia (PVD), characterized by severe pain upon contact to the vaginal entrance. Some researchers have further delineated the PVD group based on pain onset (primary vs secondary PVD, referred to as PVD1 and PVD2, respectively). AIM: This study aims to review available evidence regarding sociodemographic variables, pain characteristics, medical history and examination findings, quantitative sensory testing, genetic markers, psychosocial/sexual/relationship function, treatment outcome, and brain imaging in women with PVD1 and PVD2.
METHODS: All available data related to PVD1 and PVD2 were reviewed. MAIN OUTCOME MEASURES: There is mixed evidence supporting the assumption that women with PVD1 fare worse on all variables investigated.
RESULTS: The review indicated that although women with PVD1 seem to fare worse on many variables examined (eg, pain severity, genetic markers), many studies also indicated no significant group differences or-less commonly-that women with PVD2 fare worse on some variables (eg, sexual function).
CONCLUSION: Although it has been suggested that different pathophysiologic processes are involved in the development and maintenance of PVD1 and PVD2, the data reviewed were mixed. While most studies indicated that women with PVD1 have higher pain intensity, higher sensitivity, more genetic influence, more evidence of inflammation, lower successful treatment outcomes, and different neural activation patterns and structural findings, these results were not consistently reported. In addition, the data for subgroup differences in psychosocial, sexual, and relationship variables were not convincing. A more precise definition of primary and secondary PVD is needed, and importantly, prospective, longitudinal studies are essential for clarifying any differences within these PVD subgroups.