Although the definition, diagnosis and treatment of vaginismus have focused largely on the organic symptom of vaginal muscle spasm, the proposed etiological factors have primarily been psychogenic. The most frequently proposed include negative sexual attitudes, psychological and/or physical trauma, and relationship difficulties.
Negative Sexual Attitudes & Lack of Sexual Education
The associations between negative sexual attitudes, sexual ignorance and vaginismus have been frequently mentioned in the vaginismus literature.[1,51,55] For example, Ellison claimed that vaginismus primarily resulted from: a lack of sexual knowledge and the presence of sexual guilt both leading to a fear of engaging in intercourse.[56,57] These are consistent with Silverstein, Ward et al. and Basson's conclusion that women suffering from vaginismus hold negative views about sexuality in general and about sex before marriage.[41,51,53] However, all these studies suffer from a number of important methodological limitations such as small sample sizes (n = 22–89), lack of appropriate statistical analyses and control groups, as well as absence of standardized measurement instruments and a standardized protocol to diagnose vaginismus.[41,51,53,56,57] There are only two etiological studies of vaginismus that have included a standard statistical analysis or a control group[58,59] and only one that used a standardized measurement instrument; their results do not support the notions that women with vaginismus hold negative sexual attitudes and/or have lower levels of sexual knowledge and education.
Vaginismus has frequently been reported to result from a dysfunctional couple relationship.[60,61] The available empirical evidence is controversial. For example, Tugrul and Kabakçi's (n = 40) uncontrolled study demonstrated that 85% of vaginismic women who applied for the treatment of vaginismus and 90% of their husbands evaluated their marriages as satisfactory. Hawton and Catalan (n = 30) found that couples suffering from vaginismus have a significantly better relationship and communication when compared with 76 couples presenting other types of female sexual dysfunctions. Although relationship factors have not been empirically demonstrated to play a significant role in the etiology of vaginismus, women who suffer from vaginismus do have fewer sexual relations and avoid more sexual contact when compared with healthy controls.[50,59] It remains unclear, however, whether these are causes or consequences of vaginismus.
Partners of women with vaginismus have been reported in clinical reports to suffer from sexual dysfunction as well as to display passive and unassertive personalities.[3,26,51,57,63–65] Controlled empirical findings using standardized instruments evaluating type of personalities and male sexual dysfunction, however, have not supported this view.[26,52,58] For example, when the personality characteristics of male partners of women with vaginismus are compared with controls or norms, no differences were demonstrated. Moreover, the few studies that investigated the chronology of sexual dysfunction in partners of women with vaginismus concluded that sexual dysfunction such as erectile and premature ejaculation are generally the result rather than the cause of vaginismus.[30,64,66,67]
Sexual &/or Physical Abuse
Although the experience of sexual and/or physical abuse is generally considered an important etiological factor in vaginismus, the empirical evidence is less conclusive.[1,60,68] Five out of six studies[62,65,66,69,70] found no evidence of a higher prevalence of sexual and physical abuse. The sixth study found only weak evidence since women with vaginismus were twice as likely to report a history of childhood sexual interference (attempts at sexual abuse and sexual abuse involving touching) as compared with a 'no pain' group. Larger studies with matched control groups and well-validated definitions of abuse are required to resolve this issue.
Women's Health. 2010;6(5):705-719. © 2010
Future Medicine Ltd.