Pain with intercourse or vaginal penetration is most commonly due to provoked vestibulodynia. Stress has been found to alter pain thresholds and contribute to central sensitization by affecting the circuitry in the top-down modulation of pain from brain to dorsal horn cells.
Women with provoked vestibulodynia have lower pain thresholds in nongenital sites when compared with control subjects, and comorbidity with other chronic pain syndromes is common. Even though provoked vestibulodynia can be confirmed through physical examination and the sexual and pain symptoms are characteristic, diagnosis is typically delayed unduly.
The increasing stress of living with this condition compounds initiating stressors: central sensitization is enhanced and painful sex continues. Small-group programs providing psychoeducation and cognitive behavioral therapy or mindfulness-based cognitive therapy have been found to ameliorate the pain and suffering from provoked vestibulodynia.
While benefit from medications is similar to placebo, in individual cases some medical treatments may be considered in addition to cognitive therapy. Physicians may wish to refer patients to the BC Centre for Sexual Medicine for a full diagnostic assessment and small-group treatment. There is increasing evidence that provoked vestibulodynia is associated with central sensitization of the pain circuits within the brain and spinal cord, and that small-group psychoeducation programs can help women with this distressing condition.
Sexual health information available to young women in British Columbia is unlikely to include their one-in-five risk of consistently experiencing pain from intercourse or other penetrative forms of sex. Despite inclusion of PVD as a topic in undergraduate, postgraduate, and continuing medical education programs, we are sad to report that women are still misdiagnosed, dismissed, prescribed ineffective remedies, or told that their condition is untreatable.
