Meana et alS81) and Meana and Binik(83) suggest that dyspareunia be reconceptualized from a sexual dysfunction involving pain to a pain syndrome resulting in sexual dysfunction. Such a reconceptualization would focus on the target symptom (pain) and on the potential underlying mechanisms, rather than on possible psychological theories that have no empirical support.

Vaginismus is most likely multicausal and overdetermined in aetiology.(82) The precipitating events range from specific childhood or adult trauma to unconscious conflict, although attempts to link vaginismus to childhood or adult sexual abuse have not been empirically validated. Analytically oriented therapists have speculated that vaginismus reflects the woman's rejection of the female role, as a resistance against a male sexual prerogative, a defence against her father's real or fantasized incestual threat, and attempts to ward off her own castration images. (84> Spence(26> suggests that fears of pregnancy, strict religious adherence, disgust regarding genitalia, partner dissatisfaction, and irrational beliefs about anatomy underlie the development of vaginismus. Finally, learning theorists understand the dysfunction as a conditioned fear reaction reinforced by the belief that penetration can only be accomplished with great difficulty and will result in pain and discomfort.

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