(O-07) The psychodynamic underpinnings of premature ejaculation and vaginismus: a clinical study

Background Premature ejaculation (PE) and vaginismus are frequently relegated to biomedical or behavioral frameworks, often overlooking their role as somatic manifestations of unconscious conflicts. This study conceptualizes these dysfunctions as symbolic communications of internal relational tensions rather than mere physiological failures. Objectives To delineate the latent psychodynamic profiles, ego structures, and object relations patterns in patients with PE and vaginismus, advocating for a transition from symptom-oriented management to an integrative clinical approach. Methods A qualitative clinical case study design was utilized, involving six participants (3 PE; 3 vaginismus). Assessment tools included longitudinal clinical interviews, the Sexual Dysfunction Scale, and a projective battery comprising the Thematic Apperception Test (TAT), Draw-a-Person (DAP), and the Sacks Sentence Completion Test to elicit deep-seated unconscious dynamics. Results PE was found to be dynamically linked to castration anxiety, competence control struggles, and blurred ego-object boundaries. Projective data revealed repressed aggression toward the sexual object, where rapid ejaculation served as a defense against emotional merging and autonomy dependency conflicts. Conversely, vaginismus functioned as a psychosomatic barrier against perceived psychological intrusion, characterized by threatening parental representations, fragile ego boundaries, and pre-Oedipal fixations. The symptom emerged as a compromise formation protecting the self from reenacting early relational traumas. Conclusions PE and vaginismus function as a “somatic language” for latent relational conflicts. Effective intervention necessitates an integrative model that addresses the symbolic meaning of symptoms alongside medical protocols to ensure sustainable recovery and prevent relapse.