A woman with coital pain: new perspectives on provoked vestibulodynia

Provoked vestibulodynia (PVD) is characterized by pain at the vulvar introitus, in particular the vulvar vestibule, provoked by touch, pressure, and vaginal penetration. Although distinct and interesting hypotheses have been put forward, the pathogenesis of PVD still remains largely unknown. In general, the etiology is considered to be multifactorial. Problems arise in PVD when normal protective functions “overreact”: when normal behavior or a psychophysiological state is too extreme, too prolonged, or too intense. This attention to contextual appropriateness is one of the key principles of psychosomatic obstetrics and gynecology. It is therefore the major reason why PVD symptoms should always be put into a biopsychosocial perspective.