Does sexual trauma contribute to dyspareunia?

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Insecure attachment styles and a high somatization level are associated with sexual trauma among women with dyspareunia, according to a retrospective study.

The study in BMC Women Health, which compared 21 sexually abused women to 43 women with dyspareunia, found that sexually abused women were more likely to exhibit insecure attachment styles, specifically higher levels of avoidance (4.10 subjects of sexual abuse versus 3.08 subjects of dyspareunia), anxiety (4.20 vs. 3.49) and higher somatization (21.00 vs. 13.07).

Attachment styles were captured using the Experience in Close Relationships Scale for the degree of anxiety and avoidance, whereas the Brief Symptom Inventory assessed somatization with an emphasis on the frequency of painful and non-painful bodily complaints.

In addition, trauma was divided into three categories-sexual trauma, nonsexual trauma and no trauma-for which the attachment and somatization levels did not differ significantly between women with dyspareunia without trauma and those women with nonsexual trauma.  

Said principal investigator Michal Granot, PhD, an associate professor in the Department of Nursing, Faculty of Welfare and Health Sciences at the University of Haifa in Israel, “I was inspired to conduct this study as part of a large research project whose aim is to better understand the underlying mechanisms that lead to the development of chronic pelvic pain disorders, mainly pain during intercourse. Such pain is an unspoken phenomenon that affects so many women, decreases their quality of intimate relationships and should be explored from multi-facets perspectives.”

According to the authors, this is the first study to examine similarities and differences between women who were exposed to sexual abuse and those with dyspareunia. Previous studies of pelvic pain disorder have mainly relied on healthy women as the control group, without actively comparing characteristics of women survivors of sexual abuse to those with dyspareunia.

Dr. Granot told Contemporary OB/GYN that interestingly, a large proportion of study participants were exposed to a traumatic event. “Thus we are looking at the mechanisms involved in the relationships between the exposure to a traumatic event and the manifestation of chronic pain,” she said.

The investigators concluded that the patterns of intimate relationships in adulthood such as attachment styles that were shaped during very early childhood, and vulnerability to suffering from various pain-related symptoms in other body areas (somatization), may be associated with past trauma.

“Women who report pain during intercourse and who were exposed to a non-sexual trauma exhibit a unique manifestation of somatic symptoms,” Dr. Granot said.

However, there were no significant differences for most socio-demographic variables between the dyspareunia group and the sexual abuse group. For instance, the mean years of education were 14.81 and 13.90, respectively. 

Similarly, although the mean age of the sexual abuse group was 34.43 in contrast to 25.48 for the dyspareunia group, the median age for both groups was the same: 26 years.

One of the limitations of the pilot study is the reliability of the reports of sexual abuse because exposure to trauma occurred at a young age.

“Nonetheless, we hope that healthcare providers will take into account that alteration in the pain processing system may also stem from previous adverse life events,” Dr. Granot said. “By relying on patient-centered care models, we hope that personalized interventions for pain disorders will be tailored based on each patient's needs and individual experiences."