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
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Symen K. Spoelstra and Harry B.M. van de Wiel
18.1 Introduction and Aims 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.
18.2 Definition in Lay Terms Provoked vestibulodynia (PVD) is characterized by pain at the vulvar entrance, in particular the vulvar vestibule, provoked by touch, pressure, and vaginal penetration.
S.K. Spoelstra, MD (*) Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands e-mail: [email protected] H.B.M. van de Wiel, PhD Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands e-mail: [email protected] © Springer International Publishing Switzerland 2017 K.M. Paarlberg, H.B.M. van de Wiel (eds.), Bio-Psycho-Social Obstetrics and Gynecology, DOI 10.1007/978-3-319-40404-2_18
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S.K. Spoelstra and H.B.M. van de Wiel
18.3 Didactic Goals After reading this chapter, you will: • Be able to recognize PVD as a sexual as well as a chronic pain problem • Know that its onset often has the character of an acute disease but that this disease easily turns into a chronic pain syndrome through the particular psychological makeup of the patient or couple • Be aware of the most recent insights into diagnostic and therapeutic options in PVD • Know that a multidimensional treatment provides the best options for long-term success • Know that the key element of this treatment is to end the vicious circle of pain and fear • Be able to inform patients and partners about diagnostics and therapeutics, including complications or disturbances that may occur throughout the treatment process • Know that even after what can be considered as successful treatment, the motto at the resumption of intercourse remains: “Handle with care!”
Case History
Bianca Olive, a 30-year-old woman, para 2, enters your consultation room alone. She is referred by her general practitioner (GP) for gynecological examination. Her main problem is pain during sexual intercourse, which started after the birth of her second child, about 2 years ago. At that time she also suffered from some vaginal discharge. Her GP treated her with antimycotic vaginal suppositories against vaginal infection. The treatment alleviated her complaints for a few weeks but then the pain returned. She describes the pain as a very intense burning pain starting from
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