Painful

Behavioral Health


Step 1: View Clinicals

A couple in their early twenties complain that they have not consummated their marriage so far, despite being married for 2 years.


This is because the wife experiences severe pain in the lower vagina when penetrative intercourse is attempted.


The medical, surgical, family and drug histories of both partners are unremarkable. Nor is there a history of past sexual abuse, or psychological or social difficulties.


Both parties drink only socially, and do not smoke or use recreational drugs.


Step 2: Order Relevant Investigations

1. Pelvic Ultrasound

clear

The pelvic ultrasound scan reveals no abnormalities.

2. Urinalysis + Urine Cultures

clear

The urinalysis is unremarkable, while cultures show no growth.

3. Serum Testosterone Levels

clear

Serum Testosterone: 42 ng/dL (15 - 70)

4. Pap Smear Test

clear

The pap smear test is completely normal.

Step 3: Select Appropriate Management

1. Pelvic Muscle Relaxation Techniques

check

2. Acetaminophen

clear

3. Gradual Vaginal Dilatation

check

4. Avoid Penetrative Intercourse

clear