The Psychoanalytical View

Musaph defined vaginismus as a hysterical symptom, or a conversion symptom (18). In other words, a psychological complaint (anxiety) is changed into a physical symptom (a vaginistic reaction). According to Musaph, why some women are vaginistic whereas other are not depends on whether they have a primary disposition towards suppression as a defense mechanism; this might be towards a disrupted mother-child relationship, or other stressful situations that occurred in the oral and oedipal phase of emotional development.

Although psychoanalysis has paid a great deal of attention to the development of sexuality, very few analysts have written about treatment for vaginismus. Musaph distinguished between two forms of psychoanalytical therapy: dynamic-oriented therapy and classical psychoanalysis. The dynamic-oriented therapy form is a method to heal the symptoms, that is, the aim of therapy is to cure the neurotic reaction, in this case the vaginistic reaction. Some analysts use other resources besides the usual psychoanalytical methods, such as psychophar-maceuticals and hypnosis. Important elements in classical psychoanalysis are regression and reliving the traumatic experiences that are related to the sexual problem.

More recent research revealed that women with vaginismus have significantly increased comorbid anxiety disorders, whereas depression rates are not found to be increased (4,19,20). The role of childhood sexual trauma is unclear, since different frequency rates are found (3,4), and the presence of increased rates of posttraumatic stress disorder has not been investigated as yet. Psychological characteristics, measured with self-report instruments, do not unequivocally corroborate the presence of anxiety disorders. Personality traits found to be more often present in this group suggest the presence of self-focused attention and negative self-evaluation in the etiology or maintenance of vaginismus (3,20). Sexual functioning may be impaired with regard to sexual desire and arousal response during sexual activity. Psychopathology and impaired psychological functioning may be caused as well as effect of vaginismus. Experimental evidence thus far documented the role of experienced threat in increased pelvic floor muscle tension, but did not discriminate between women with and without vaginismus (10,21,22). The causation and maintenance of vaginismus by psychological factors thus remain unresolved although fear of penetration and associated attentional bias may play a role. So far, no randomized controlled trials of psychological treatment for vaginismus have been published.

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