Alexithymia and Vaginismus: a Preliminary Correlation Perspective

Alexithymia and Vaginismus: a Preliminary Correlation Perspective

International Journal of Impotence Research (2013) 25, 113–116 & 2013 Macmillan Publishers Limited All rights reserved 0955-9930/13 www.nature.com/ijir ORIGINAL ARTICLE Alexithymia and vaginismus: a preliminary correlation perspective G Ciocca1, E Limoncin1, S Di Tommaso1, GL Gravina1, S Di Sante1, E Carosa1, A Tullii2, A Marcozzi2, A Lenzi3 and EA Jannini1 The aim of this study was to measure the prevalence of alexithymia and emotional dysregulation in women with vaginismus not associated with other organic or psychopathological disorders. The study involved the psychometric assessment of 41 patients with vaginismus and 100 healthy women, all of childbearing age. Alexithymia was evaluated by TAS-20 (Toronto Alexithymia Scale). Sexual function was assessed by FSFI (Female Sexual Function Index). In patients with vaginismus, the primary diagnosis of dyspareunia was excluded and an expert psychologist evaluated patients and controls according to DSM IV (Diagnostic and Statistical Manual of Mental Disorders: 4th edition) criteria to exclude mental disorders. Over half (51.1%) of the patients with vaginismus were classified as alexithymic or borderline (alexithymic trend), compared with just 18% of the control group. In addition, there was a significant difference in the TAS-20 total scores between the two groups (Po0.0001). In terms of relative risk, women suffering from vaginismus thus have a 3.8 times higher probability of showing alexithymia than do healthy women. Vaginismus is a complex syndrome and alexithymia is far from being its only characteristic. However, we found a significant correlation between vaginismus and alexithymia. In theory, alexithymia could thus be a risk factor for vaginismus, although future studies are required to demonstrate any chain of causation between these two conditions. International Journal of Impotence Research (2013) 25, 113–116; doi:10.1038/ijir.2013.5; published online 7 March 2013 Keywords: alexithymia; emotional dysregulation; gynaecological examination; sexual dysfunction; vaginismus INTRODUCTION Statistical Manual of Mental Disorders: 4th edition) Axis I 14 The word alexithymia is derived from Greek and is defined as the psychopathological disorders. It is a complex symptom that is lack of words for emotions. The term was coined by Peter Sifneos sometimes associated with coital pain (dyspareunia) and in 1973 after conducting clinical observations on psychosomatic sometimes with pre-existing organic disorders. It is found in patients.1 1–2% of post-pubertal women and accounts for 15–17% of clinical Alexithymia has been described in patients with psychosomatic cases in sexology, thus suggesting a very common epidemiolo- 15 disorders.2 Alexithymic individuals are characterised by limited gical diffusion. imaginary processes, as evidenced by a scarcity of fantasy, While vaginismus can have a physical cause, in most impaired ability to identify and communicate emotions, cases its aetiology is psychological. Sufferers are afraid of vaginal externally oriented thinking and tendency to somatisation.3 They penetration and produce an involuntary somatic and genital lack the ability to mentalise and transduce emotional arousal into response to this fear with a neuromuscular reaction which 16 a mental concept. To a certain extent, their emotions are confined prevents such penetration. According to Masters and 17 to a solely bodily level. Johnson, the psychological causes range from strict religious The main aetiological and pathogenetic observations on observance to trauma can also have a fundamental role. Most alexithymia can be attributed to neurophysiological, psychoevolu- authors in fact believe that child abuse, sexual harassment and tionary and psychotraumatological causes.4 sexual abuse or rape are predominant factors in the pathogenesis 18 Neurophysiologically, there is an impaired neural interaction of vaginismus. between the limbic system and the cortex, with specific damage To date, alexithymia has been considered mainly a masculine 19 to the anterior cingulate cortex and failed interhemispheric trait, and has not been explored much in women. The main integration.5,6 purpose of this study is to assess and evaluate any correlation Alexithymia may worsen in the presence of insecure and between alexithymia and vaginismus. avoidant attachment styles.7,8 Moreover, the condition is directly associated with traumatic experiences. In post-traumatic conditions, MATERIALS AND METHODS the psychic system reacts by restricting emotional response.9 Impaired cognitive processing and emotional regulation are also Sample recruitment found in patients with various psychosomatic disorders, including In all, 44 women with lifelong vaginismus and 109 healthy women were male sexual and reproductive dysfunctions.10–13 recruited at the University’s Sexology Unit and assessed by Toronto Alexithymia Scale (TAS-20) and Female Sexual Dysfunction Index (FSFI), Vaginismus is a common, multifaceted sexual dysfunction two widely used and well-validated scales for the assessment of defined as ‘a recurrent and persistent involuntary spasm of the alexithymia20,21 and female sexual function.22 All the sample was musculature of the outer third of the vagina that interferes with recruited sequentially by a gynaecologist and a psychologist, on the sexual intercourse’ not associated with DSM IV (Diagnostic and base of a fundamental criteria absence/presence of vaginismus. 1Department of Clinical, Applied and Biotechnological Sciences, School of Sexology, University of L’Aquila, L’Aquila, Italy; 2Department of Obstetrics and Gynaecology, Teramo Hospital, Teramo, Italy and 3Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. Correspondence: Professor EA Jannini, Department of Clinical, Applied and Biotechnological Sciences, School of Sexology, Faculty of Psychology, University of L’Aquila (Coppito), Building 2, Via Vetoio, L’Aquila 67100, Italy. E-mail: [email protected] Received 3 May 2012; revised 30 November 2012; accepted 5 February 2013; published online 7 March 2013 Alexithymia and vaginismus G Ciocca et al 114 In fact, after a careful gynaecological examination, patients complaining RESULTS of vaginismus not due to a primary diagnosis of dyspareunia were selected 23,24 Table 1 lists the main sociodemographic characteristics of the study by our gynaecologist for the patient group. population. The mean ages of the control and patient groups were They were evaluated by a psychologist according to DSM IV criteria, to exclude other DSM IV Axis I disorders. The DSM IV diagnostic criteria that 29.3 (s.d. ¼ 5.9) and 29.8 (s.d. ¼ 9) years, respectively, with no we used for the diagnosis of vaginismus were (A) recurrent or persistent significant difference (P ¼ 0.71). There were no statistical differences involuntary spasm of the musculature of the outer third of the vagina that with respect to educational level between the groups (Table 1). interferes with sexual intercourse; (B) the disturbance causes marked The mean of FSFI total score of the control and vaginismic distress or interpersonal difficulty; (C) the disturbance is not better groups were 33.6 (s.d. ¼ 5) and 4.1 (s.d. ¼ 4.3), with a significant accounted for by another Axis I disorder (for example, somatisation difference (Po0.0001). disorder) and is not due exclusively to the direct physiological effects of a There was a significant difference in the TAS-20 scores between general medical condition. the two groups (Po0.0001) (Table 2), with a mean value of 51.6 in Of the 44 patients who were administered the test, 3 were excluded due the patient group against 40.5 in the controls (mean to errors or omissions in completing the TAS-20 test form. A total of 41 women with vaginismus thus took part in the experimental group. They difference ¼ 11.1). Considered as a whole, the patient group had were all of childbearing age (average age 29.8 years). significantly higher values of alexithymia than the healthy An age and education-matched control group consisted of healthy volunteers (Table 2). women with a normal sexual function was also recruited. Of the 109 Using a TAS-20 cutoff score of 61 for the 41 patients diagnosed controls recruited, 9 were excluded due to dysfunctional FSFI scores. The with vaginismus, 26.8% (11/41) were identified as alexithymic, average age of the remaining 100 controls was 29.3 years. 24.3% (10/41) as borderline and 48.7% (20/41) as not alexithymic. Also, the controls were evaluated by a psychologist and a gynaecologist In the control group, 7% (7/100) were identified as to exclude mental or gynaecological disorders. alexithymic, 11% (11/100) as borderline and 82% (82/100) as not alexithymic. These differences are significant (Figure 1). Patient group inclusion criteria The cumulative percentage of patients with alexithymic or Women of childbearing age with lifelong and generalised vaginismus not borderline (alexithymic trend) scores was 51.1% (21/41), indicating associated with a primary diagnosis of dyspareunia or any other organic or that a considerable number of women with vaginismus react in psychopathological condition. such a way as to suggest that their capacity for emotional processing is partly or completely absent. In contrast, the Patient group exclusion criteria cumulative percentage of alexithymic and borderline scores in Women not of childbearing age or menopausal, women with other the control group was just 18% (18/100), significantly lower than gynaecological disorders; women with mental disorders. in the patient

View Full Text

Details

  • File Type
    pdf
  • Upload Time
    -
  • Content Languages
    English
  • Upload User
    Anonymous/Not logged-in
  • File Pages
    4 Page
  • File Size
    -

Download

Channel Download Status
Express Download Enable

Copyright

We respect the copyrights and intellectual property rights of all users. All uploaded documents are either original works of the uploader or authorized works of the rightful owners.

  • Not to be reproduced or distributed without explicit permission.
  • Not used for commercial purposes outside of approved use cases.
  • Not used to infringe on the rights of the original creators.
  • If you believe any content infringes your copyright, please contact us immediately.

Support

For help with questions, suggestions, or problems, please contact us