19 yr old with vaginismus
From: douglas krell (douglas.krell@nsionline.com)
Sun Aug 3 22:53:02 1997
A older patient of mine brought her 19 yr old daughter in to see me last
week for a PAP. Upon trying to insert a narrow pederson speculum, it
was apparent that the patient suffered from vaginismus. The hymen was
not intact.
She complained of severe pain in the vaginal introitus for as long as
she could remember. She had never used tampons nor has she had sexual
intercourse. She never recalls even having touched her own vagina. Her
17 year old sister has already had a baby and the patient is now
beginning to worry that she is not normal. She has a boyfriend who is
beginning to suspect that there is a problem since the patient shows no
interest in sexual activity of any kind.
Who among you has had a successful outcome in treating such a patient
and what is the ideal way to approach this patient's problem? Normally
for milder cases I've used graduated dilators, but in this situation
where the woman has not even been able to take the first steps, I
believe that psychiatric experience or hypnosis may be of benefit.
Should this patient go to the OR for a careful exam or perhaps get an
ultraound of the pelvis?
How would others approach this patient's problem?
Doug
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Douglas J. Krell MD FACOG
Galisteo OB/GYN Associates PC
Santa Fe, New Mexico
"Consistency is the last refuge of the unimaginative" - Oscar Wilde
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