Provoked vestibulodynia (PVD) can be primary or secondary: Primary: Is present from the first experience with penetration (whether by insertion of a tampon, a speculum examination, or sexual intercourse) Secondary: Develops in patients who have previously been able to have comfortable, pain-free penetration The etiology of PVD is not entirely understood and may result from multiple factors, possibly including an inflammatory or immune response, an increased number of nerve fibers resulting in hyperesthesia, a hormonal imbalance, and pelvic floor dysfunction.