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Objective: Although vaginismus is classified under the title of "sexual pain disorders", its etiological roots are still controversial. It has been suggested that vaginismus should be considered as a phobic reaction resulting in an avoidance behavior due to a dominant fear of pain. It has also been argued that, in patients with vaginismus, other fears usually accompany the fear of pain during coitus. Excessive sensitivity particularly in the genital area is said to prevail in vaginismus. In our study, patients with vaginismus were compared to a healthy group in terms of commonly seen phobias, amplified perception of somatic sensations and sensitivity to pain
Method: As a part of a different aspect of a vaginismus trial 40 subjects with vaginismus, who was referred to the Sexual Functioning Disorders outpatient clinic and agreed to take part in the study and 50 women of the control group who described penile penetration difficulty and pain during coitus, were evaluated. The participiants were evaluated using a sociodemographic form developed by the researchers, the SCL-90-R (Symptom Checklist-90-Revised), and the Somatosensory Amplification Scale Halam and Hafner (1977) fear checklist. The data were analysed using the SPSS for Windows 10.0 statistical packet program and P<0.05 was considered to be significant.
Results: The subjective pain endurance and total SSAS scores were not statistically significant. In reported fear of pain, dryness, narrowness and pain during coituswas highly significantly different between the two groups. A statistically significant difference was found in the vaginismic group as compared to the control group when items in the Fear Questionnaire for Phobia 11 (Closed Small Rooms), Phobia 15 (Being in High Places), Phobia 37 (Seeing Others' Nausea or Vomiting), Phobia 41 (Seeing Blood ) and Phobia 46 (Going to a Dentist) were assessed one by one. When the subscale scores were evaluated, a statistically significant difference was found only in the F subscale (Diseases and Injuries).
Discussion: It seemed from these results that the fear of feeling pain during coitus and the sensations of narrowness, dryness and pain during coitus are important variables contributing to the etiology of vaginismus. It was thought that the fear of pain during coitus and the fear of somatic injury might trigger a perception of threat and this could explain the muscle spasm used in the definition of vaginismus. The statistical significance of the high level of the fear of bleeding and the fear of a dentist, which might symbolize the fear of pain, was thought to indicate this relationship. Again, it was considered that the thoughts of bleeding during coitus and pain and the somatic injury following it might have a relationship with the high scores in the fear of disease and injury scale. As in all of the sexual function disorders, a diagnosis of vaginismus should also rely on evidence-based criteria rather than on a consensus of specialist views. We think that large-scale studies integrated with clinics are needed to obtain such evidence-based criteria