Snapshot A 40-year-old, recently divorced, woman presents with pain upon sexual intercourse. When attempting intercourse after her divorce, there was severe pain upon penetration, forcing her to end sexual intercourse. Upon further questioning, she reveals that she is a sexual assault survivor. On physical exam, there is involuntary vaginal muscle contractions during pelvic examination. INTRODUCTION Vaginismus is a sexual pain disorder login to view 3 more bullets Vaginismus is the only type of sexual dysfunction that can be diagnosed with physical exam Risk factors login to view 4 more bullets Associated conditions login to view 2 more bullets ETIOLOGY Pathogenesis login to view 3 more bullets Presentation Symptoms login to view 2 more bullets Physical exam login to view 1 more bullet Differential Diagnosis Dyspareunia Psychological (e.g. performance anxiety) DIAGNOSIS Diagnosis confirmed if vaginal muscles contract involuntarily with pelvic exam Treatment Gradual vaginal dilators Physical therapy to relax the tight muscles Counseling Prognosis Vaginal dilators are typically very successful