Aetiology of vaginismus

Psychoanalytic explanations

Classic psychoanalytic theory considers vaginismus to result from unresolved psychosexual confl icts in early childhood. Women with the condition have been characterized as fi xated or regressed to the pre-oedipal or oedipal stages. According to Abraham (1956), in less severe cases, women are not able to transfer their libidinal energy from their father to their husband/partner. In more severe cases, women remain fi xated on their mothers, and have a poor prognosis.

Behavioural explanations

According to behavioural theory, vaginismus is a phobic reaction to actual or imagined negative experiences related to penetration. Fear or anxiety concerning penetration results in high levels of sympathetic nervous system activity, one of the results of which is involuntary vaginal muscle spasm. These fears may, in part, arise from ignorance of sexual issues. Three other factors may increase the fear reaction (Ward and Ogden 1994). First, a mother who is frightened of intercourse may pass a fear of pain to her daughter. Second, the experience of sex may be painful for the affected woman, and memories of pain trigger the symptoms: nearly three-quarters of women with vaginismus in Ward and Ogden’s sample reported this type of fear. The third issue involves a fear of punishment related to sexual guilt. Ward and Ogden found that many women with vaginismus experienced sexual guilt, stemming from a belief that ‘sex is wrong’, which led to a fear of punishment for engaging in sexual acts. Childhood sexual trauma and a background of religious orthodoxy may also contribute to the conditioning of fear or guilt in relation to intercourse.

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