Frigidity may be due to an organic cause, in which case the differential diagnosis is similar to dyspareunia , or it may be functional. The organic causes can be recalled with the mnemonic MINT. M—Malformations include a hood clitoris or imperforate hymen, vaginal stenosis, hermaphroditism, retroverted uterus, and Turner syndrome. I—Inflammation suggests vaginitis, bartholinitis, endometritis, or salpingitis. N—Neoplasms recall neoplasms of the vagina, cervix, uterus, and ovary; endometriosis; and neurologic conditions such as multiple sclerosis or peripheral neuropathy (diabetes). T—Trauma includes introduction of a large male organ, masturbation, or previous rape, in addition to the emotional trauma discussed below. Unfortunately, this does not include the numerous hormonal causes of frigidity (e.g., menopause, hypopituitarism, Stein–Leventhal syndrome, and adrenal tumors). Obesity would seem to be another “organic” cause of frigidity, but this may simply be another sign of a functional disorder. Functional or psychogenic causes of frigidity include all the neuroses and psychoses, especially schizophrenia and endogenous depression, as well as specific feelings of fear or hostility related to intercourse. These may be grouped into conscious or unconscious feelings. Conscious fears include a fear of pregnancy or, if pregnant, fear of damage to the fetus. It would also include fear of not being able to consummate the marriage and have a child. Another important conscious fear that many women have is that they will not be able to satisfy the husband or that they themselves will not reach a climax. Conscious hostility may be based on a disgust for male superiority or anger at the husband for the way he treats her parents or other relatives or for his lack of respect for her. She may be disgusted because his lack of technique or premature ejaculation prevents her from reaching orgasm. Unconscious fears include repressed anxiety from previously being raped in childhood, repressed anxiety from previous incest, and repressed guilt that sex is dirty. Unconscious hostility may come from a castration complex or a reluctance to identify with the feminine role.
The approach to the diagnosis here is to examine the patient and husband for organic causes and perhaps even do FSH, estradiol, and other hormone blood levels. Estrogen replacement therapy may be indicated in menopause. If no organic cause can be found, referral to a psychiatrist or sex therapist is indicated. A reassuring, personable, and interested physician, however, may be quite capable of determining the psychologic cause, especially if it is in the conscious mind.