What are the causes of vaginismus?
The causes of vaginismus are likely to be varied, many relationships have been observed over the years. Below are some of the most well established.
Causes of vaginismus – Pain and threat Vaginismus
Vaginismus is heavily associated with vaginal pain from penetration or attempted penetration however it appears that the fear of pain is the more significant cause (Ward & Ogden 1994). There is evidence that fear of pain is higher in vaginismus sufferers than in women with Dyspareunia, a condition defined by the presence of vaginal pain (Borg et al 2012). There are many possible causes of the fear of pain in sufferers, prominent amongst these are past experience of vaginal pain and the fear induced by expectations of pain associated with the fear of rupturing the Hymen. Fear or threat causes muscles to tense, a phenomenon referred to as ‘body shielding’, an evolutionary response designed to tighten muscles against a potential blow or impact. Generally, in a fear situation the whole body is tensed, which includes the vaginal muscles. What is particularly interesting is that women with vaginismus appear to have heightened pelvic muscle tensing (van der Velde, & Everaerd, 2001).
Causes of vaginismus – Disgust
It would seem natural that women with a greater dislike of the idea of sex and sex related matters are more likely to be uncomfortable about having sex and thus initiate the ‘body shielding’ response. Studies have shown a generally elevated propensity towards disgust and feelings of contamination in response to sexual stimuli in women with vaginismus (Borg et al 2010, De Jong, et al.2009) with a causal relationship being identified with lifelong sufferers (Reissing 2012), and a reduced readiness to enter into certain sex related behaviours when compared to controls (Borg et al 2011).
Causes of vaginismus – Sexual Abuse
It would make sense that having experienced sexual abuse is likely to a woman off sex, even in a consensual relationship, and this does indeed appear to be the case for some women. A statistically significant correlation has been demonstrated between early life sexual abuse and development. One study found that women with vaginismus were twice as likely to have a history of sexual abuse than a sample of demographically similar women (Reissing, 2003). However, one postal study of 89 sufferers ranked it as the least important cause (Ward & Ogden 1994) identified by sufferer’s. Crowley et al (2009) highlight that aversive sexual experience, a broader category than abuse, and one which may take in unexpectedly rough consensual sex, painful sexual experience due to the rupturing of the Hymen, may be important in development, but evidence is only anecdotal.
Causes of vaginismus – Self-esteem and self-perception
The relationship between self-esteem / self-perception and general psychological wellbeing is a tricky one and vaginismus researchers have some interesting correlations. One study identified that woman with vaginismus had lower levels of positive sexual memories and beliefs (Reissing et al 2003). Another study found that women with primary vaginismus had low levels of self-esteem in general (Kennedy et al 1995), however the same study found no improvement in self-esteem for the female partner following sex-therapy, suggesting that possibly the low self-esteem came first. Personality research has shown that sufferers have higher levels of anxiety and neuroticism, and lower extroversion on the ‘big 5 personality traits’ when compared to controls (Watts & Nettle 2010).
Causes of vaginismus – Partners
It has been observed in case studies that women with vaginismus have a tendency to be with men who are ‘submissive, sympathetic and gentle’. This has been argued to be a possible ‘collusive psychopathology’ (Cooper 1969). To put it another way women with vaginismus or vaginismus prone personalities seek out men they know will be understanding. Silverstein’s review of 22 case studies (1989) found that most sufferers had domineering and threatening fathers, and argues that they go on to choose partners who represent the opposite of this. One Turkish study which attempted to address this issue (Dogan & Dogan 2007) looked at 32 male partners of women with vaginismus and found that 65.6% met DSM-IV-TR criteria for one or more male sexual dysfunctions, which is more than double that which some large scale studies of a general western populations have found (Laumann,& Rosen, 1999). The trend in these results has been repeated in a second larger scale (580ss) Turkish study, by different authors, which found a 61.03% rate of sexual dysfunction amongst male partners (Eserdag et al 2012). It would appear that women who seek gentlemen also find men who seek sexually unthreatening women and as such there is less impetuous within the relationship from either side to change the situation
Causes of Vaginismus – Other factors
· Strong moral environments are often cited as a potential cause (Masters & Johnson 1980, Pacik 2011, Silverstein 1989), but there is as yet little quality research evidence to confirm this supposition (Crowley et al 2009).
· lack of sexual education, formal or otherwise, may be another factor. With higher levels of vaginismus being noted in cultures with restrictions on girls and young women discussing sex and a high value on a brides virginity (Crowley 2009).