Vaginismus, Dyspareunia and Abuse History: A Systematic Review and Meta-analysis

Abstract

Background Genito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder. Aim This systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis. Methods Related keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I2 statistic. Outcomes Case-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse. RESULTS A significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14–2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24–2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03–2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia. Clinical Implications This systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment. Strenght and Limitations The strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias. CONCLUSION The study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse.

Experiences of Dyspareunia in Dominican Women with a History of Sexual Abuse: A Phenomenological Study

“…Although the sexual difficulties associated with dyspareunia have been studied, 14,39 this study suggests that patients with dyspareunia may have a history of sexual abuse instead of causes such as gynecological conditions, consequence of childbirth, or perineal trauma. A recent study found a significant link between sexual abuse and dyspareunia 23 . Furthermore, consistent with our findings, studies have shown that women with dyspareunia experience pain during sexual intercourse throughout their lives but do not talk about it or seek treatment or professional help due to feeling shame 40,41 .…”

“…A recent study found a significant link between sexual abuse and dyspareunia. 23 Furthermore, consistent with our findings, studies have shown that women with dyspareunia experience pain during sexual intercourse throughout their lives but do not talk about it or seek treatment or professional help due to feeling shame. 40,41 Our study's participants expressed that sexual abuse during childhood and adolescence was a taboo subject, that they felt ashamed, and that they were too inhibited to talk about the subject with their family members and partners.…”

“…14,21 Previous studies have found that the risk of dyspareunia was 1.74 times higher in women who had a history of sexual assault, and a meta-analysis study showed that history of prior sexual abuse was 1.53 times higher among women with dyspareunia. 22,23 Childhood abuse and its possible association with dyspareunia has been the subject of many studies, but the results lack consistency. There is a wealth of quantitative research on factors associated with dyspareunia 24,25 : its impact on childbirth 26 and on the type of birth and perineal trauma, 27,28 as well as on pharmacologic treatment 29 and rehabilitation.…”

“…Sexual abuse has been associated with painful intercourse, decreased frequency of sexual contact, dissatisfaction with sexual activities, and arousal and orgasmic disorders 14,21 . Previous studies have found that the risk of dyspareunia was 1.74 times higher in women who had a history of sexual assault, and a meta‐analysis study showed that history of prior sexual abuse was 1.53 times higher among women with dyspareunia 22,23 …”

Common Pitfalls in the Management of Vaginismus in Couples With Subfertility in India

“…3 In addition, vaginismus also has psychosocial and interpersonal components (fear, anxiety, depression, shame, embarrassment, self-image, and relationship difficulties). 4 Some common predisposing factors in the presentation of lifelong vaginismus are poor sexual health literacy, guilt about sexual pleasure, highly restrictive values-based sexual scripts, and childhood sexual violation/abuse 5 whereas untreated local organic pathologies and ongoing relationship conflicts have been postulated to be important perpetuating factors of vaginismus. 6 Often, vaginismus comanifests with a wide range of concerns relating to general, relational, and psychosexual well-being.…”