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A Comparison of Demographic and Psychosexual Characteristics of Women With Primary Versus Secondary Provoked Vestibulodynia

Brotto, Lori A. PhD*; Sadownik, Leslie A. MD*; Thomson, Sydney MD*; Dayan, Marcy BScR, MHA; Smith, Kelly B. PhD*; Seal, Brooke N. PhD; Moses, Melissa BA*; Zhang, Areiyu MD§

The Clinical Journal of Pain: May 2014 - Volume 30 - Issue 5 - p 428–435
doi: 10.1097/AJP.0b013e31829ea118
Original Articles

Objectives: Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting approximately 12% of premenopausal women. It has been speculated that primary (ie, lifelong) and secondary (ie, acquired) PVD may represent 2 distinct conditions with different etiologies. There is also evidence that primary and secondary PVD subtypes may respond differently to conventional treatments. The goal of this study was to compare the demographic, clinical, and psychosexual characteristics of a large sample of premenopausal women with primary and secondary PVD.

Methods: A total of 132 premenopausal women (n=42 primary; n=90 secondary) with PVD who sought treatment in a Multidisciplinary Vulvodynia Program completed demographic questions and a battery of validated self-report measures before treatment.

Results: Women with primary PVD had a longer duration of PVD as well as more time before diagnosis. Women with secondary PVD reported significantly more clitoral hood pain, higher overall vestibular pain levels, more overall sexual dysfunction and sex-related distress, and proportionately more intercourse occasions that were painful. Women with primary pain stated they had significantly more dysmenorrhea and were more likely to report that their partners were unaware of their PVD symptoms. There were no significant subtype differences on any psychological measure but a trend towards higher magnification of symptoms in women with secondary PVD.

Discussion: Overall the findings suggest some important differences in the characteristics of women with primary versus secondary PVD which may have management-related implications.

*Department of Gynaecology

§Faculty of Medicine, University of British Columbia

Dayan Physiotherapy and Pelvic Floor Clinic, Vancouver

Department of Psychology, University of the Fraser Valley, Abbotsford, BC, Canada

The authors declare no conflict of interest. Funding for the Multidisciplinary Vulvodynia Program came from a private donation from the Mrs Leslie Diamond Foundation, Vancouver, BC, Canada. M.D., K.B.S., and B.N.S. were employed as clinicians on this study. K.B.S. was supported by Postdoctoral Fellowships from the Michael Smith Foundation, Vancouver, BC, Canada; for Health Research and the Canadian Pain Society, Oshawa, Ontario, Canada.

Reprints: Lori A. Brotto, PhD, Department of Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada (e-mail:

Received November 6, 2012

Accepted May 25, 2013

© 2014 by Lippincott Williams & Wilkins