Aetiology

aetiology

Aetiolgy of vaginismus is unknown.

Numerous causes of painful intercourse have been reported in the literature:

• superficial pain
  • lack of sexual arousal - more common in women with diabetes, multiple sclerosis, or spinal cord injury
  • vulvovaginitis caused by trichomoniasis, herpes simplex infection, candidiasis, furunculosis
  • atrophic vaginitis
  • vulvar dermatoses e.g. - lichen sclerosus, lichen planus,
  • drugs or radiohareapy
• deep pain
  • endometriosis
  • pelvic inflammatory disease (1)

In addition the following factors are thought to be associated with the condition:

• sexual molestation
• strict sexual or religious upbringing
• waiting until marriage to have intercourse
• fear of first-time sex e.g. - pain, bleeding, tearing, ripping, penis too large, vagina too small, sexually transmitted diseases, fear of pregnancy
• fear of gynecological examinations
• undesirable penetration while being restrained at a young age such as urinary catheterization, enemas
• stretching a vagina "that appeared too small"
• family history of vaginismus (2)

Note:

• a qualitative study carried out on the experience of vaginismus with 89 participants revealed that the three most common contributing factors were - fear of painful sex, the belief that sex was wrong or shameful, and traumatic early childhood experiences (1).

Reference:

• (1) Crowley T, Goldmeier D, Hiller J. Diagnosing and managing vaginismus. BMJ. 2009;338:b2284
• (2) Pacik PT et al. Understanding and treating vaginismus: a multimodal approach. Int Urogynecol J. 2014;25(12):1613-20.