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Re: 19 yr old with vaginismusFrom: Diana Corson (corsond@ohsu.EDU)Mon Aug 4 23:03:12 1997
I notice this young woman was brought in by her mother. I wonder if The Mother thought she Should have a Pap/exam or if this young woman really wanted an exam. hmmmmm Since her hymen was not intact, I would consider that she may have been assaulted and so would benefit from Pap screening. However, I would involve this woman in the decision making process of what to do next. Would she like to take a chance that she doesn't have cancer, try to address the vaginismus, and then try again for a Pap? or would she like to proceed with the Pap despite the vaginismus? Is the vaginismus triggered by a pain response to vulvar disease? I like the idea of general anesthesia. However, her body will still experience the invasive procedure despite the anesthesia and this might compound the original problem of vaginismus. Perhaps an epidural--she could at least be aware on a conscious level of what is happening with her body. I take note of the comment that this young woman's boyfriend has a concern, but the woman herself does not want to be sexually active. Perhaps her body is trying to protect her from doing what she does not want to do. Perhaps her sexual identity has a role here. Could she be repressing "unacceptable" same-sex desires and again her body is protecting her from doing what she considers "unacceptable"? The provider can let her know that it is perfectly normal to question sexual identity. Does her religion play a role? Has she been indoctrinated to believe that touching herself is bad? Does she trust the provider? She did presumably just meet Doug for the first time. Would she feel more comfortable with a nurse-practitioner or nurse-midwife who might be able to take more time with her at the visit and who most likely would be another woman? I agree that hypnosis may be helpful. I might also suggest accupuncture as an adjunct to counseling. lurker Diana Corson, CNM Milwaukie Birth Center, Portland, OR On Sun, 3 Aug 1997, douglas krell wrote:
> A older patient of mine brought her 19 yr old daughter in to see me last
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