LAUSR

ABSTRACT Primary provoked vestibulodynia (PVD) is marked by onset of symptoms at first provoking vulvar contact, while secondary PVD refers to symptom onset after some period of painless vulvar contact. Different pathophysiological processes are thought to be involved in the development and maintenance of primary PVD and secondary PVD. The primary aim of this study was to test the hypotheses that the resting state functional connectivity of the brain and brainstem regions differs between these subtypes. Deep clinical phenotyping and resting state brain imaging were obtained in a large sample of a women with primary PVD (n=46), secondary PVD (n=68) and healthy controls (n=94). The general linear model was used to test for differences in region-to-region resting state functional connectivity and psychosocial and symptom assessments. Direct statistical comparisons by onset type indicated that women with secondary PVD have increased dorsal attention-somatomotor network connectivity whereas women with primary PVD predominantly show increased intrinsic resting state connectivity within the brainstem and the default mode network. Furthermore, women with secondary PVD compared to primary PVD reported greater incidence of early life sexual abuse, greater pain catastrophizing, greater 24-hour symptom unpleasantness and less sexual satisfaction. The findings suggest that women with secondary PVD show greater evidence for central amplification of sensory signals whereas women with primary PVD have alterations in brainstem circuitry responsible for the processing and modulation of ascending and descending peripheral signals.