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Introduction: Psychological vulnerability is a relevant component of polycystic ovarian syndrome (PCOS), but it is still under-explored, especially during adolescence. The aim of this study was to describe a selection of psychometric characteristics in a clinical sample of Italian adolescents with PCOS. Moreover, we reported the associations of body image, eating attitudes, and mood with metabolic features. Methods: Our sample included 128 adolescent girls (age range: 14–19 years) with PCOS. Validated psychometric questionnaires were administered: State Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Body Attitude Test (BAT), Bulimia Investigation Test (BITE), Eating Attitudes Test (EAT), and Perceived Stress Scale (PSS). Results: Anxiety was the most prevalent mood disorder (63.1% trait anxiety and 57% state anxiety). Our cohort also showed a high prevalence of depression (39.1%), body image dissatisfaction (49.2%), disordered eating (11.7%), and bulimic risk (41.4%). PCOS adolescents with obesity and insulin resistance (IR) had statistically significant higher body image distress compared to those with normal weight and without IR (p < 0.001). The Sobel test for mediation showed that body image dissatisfaction mediates the relationship between state anxiety and bulimic risk (Z = 3.42, p < 0.001) and between depression and bulimic risk (Z = 4.59, p < 0.001). Conclusions: A considerable number of patients with PCOS experience psychological disorders during adolescence. IR and obesity play a role in the distress associated with body image, further contributing to psychological vulnerability, especially in the bulimic domain. A comprehensive biopsychosocial approach in adolescents with PCOS represents the basis for effectively managing and preventing complications arising from both psychological and biological disorders in adulthood.

Vulvodynia is a chronic pain condition, without clearly identifiable and visible causes, associated with disability, sexual disfunction, and impaired quality of life. It is frequently under-reported and under-diagnosed, resulting in significant emotional burden. The pathophysiology of vulvodynia is complex and multidimensional. According to the integrated biopsychosocial model, main triggers of vulvodynia may be biological (infectious or inflammatory conditions inducing severe or prolonged nociceptive or neuropathic pain, genetic predisposition, hormonal imbalance), psychological (depression, anxiety), sexual (traumatic experiences, unhealthy intimate relationship), and social (adverse childhood experiences). The diagnostic approach is based on accurate medical history exploring the characteristics and timing of vulvar pain, as well as the presence of other chronic pain conditions that are often comorbid. Pelvic examination (vulvar and vaginal appearance, cotton swab test for vulvar sensitivity, pelvic floor evaluation) supports the diagnosis and excludes secondary vulvar pain disorders. Considering that pain is a complex human experience within a multidimensional frame, the best therapeutic strategy should be multidisciplinary encompassing different therapeutic targets. Pharmacological therapies have anti-nociceptive, neuromodulating, and anti-inflammatory purposes and include both topical and systemic treatments (antidepressants, anticonvulsants, hormonal creams). Physical therapy consists of pelvic floor physiotherapy, electrostimulation, and neuromodulation techniques, while cognitive behavioral therapy, psychosexual intervention, and neurobiological education address the psychosocial dimension of vulvodynia. If results are insufficient, a surgical approach is allowed. We present a clinical case linking amelioration of vulvodynia to a training program to increase muscle mass, especially in the lower limbs, in a girl reporting an eating disorder.