Early relationship experiences in women with sexual pain: a psychodynamic approach to the interactional function of body symptoms

Abstract

Sexual pain and difficulties with sexual intercourse in women, formerly diagnosed as dyspareunia and vaginismus and reconceptualised as genito-pelvic pain/penetration disorder (DSM-5) or sexual pain-penetration disorder (ICD-11), have caused widespread discussions in the clinical and scientific community for decades, mainly due to differential-diagnostic difficulties. Meanwhile, their developmental origin has remained under-theorised. Standard diagnostic guidelines like ICD or DSM lack psychodynamic considerations about their origins. Valuable approaches to understanding those phenomena have been commonly neglected. The aim of this study was to compare inductively obtained information from women with experiences with vaginismus (n=17) and dyspareunia (n=11) about their relationships with primary caregivers from biographic-narrative interviews. Our mixed-method analysis involved two steps: a first qualitative assessment drew on psychoanalytically informed research principles and the development of a coding frame, which was used by two independent raters to code the material; in a second step, coded experiences were statistically compared between the two groups using Fisher’s exact tests to explore similarities and differences. Integrating results with theoretical psychodynamic work, we suggest that the postulation of interactional functions of conversion and somatisation, based on early experiences with primary objects, adds significantly to the conceptualisation of dyspareunia and vaginismus. Results indicate that vaginismus might represent a conversion symptom with a triangulating function, whereas dyspareunia might be understood as a form of somatisation and serves the purpose of replacing the primary object. The results are discussed in the light of previous theoretical outlines of women’s genital pain and includes strengths and limitations of our proposition.