Snapshot A 21-year-old woman presents tearfully to her gynecologist. She has a new partner but is having difficulty with intercourse. She has a lot of anxiety surrounding sexual contact. On pelvic exam, her vaginal muscles contract involuntarily. Her physician recommends therapy and treatment with gradual dilators. Introduction Vaginismus is a sexual pain disorder vaginismus results in difficulty allowing vaginal penetration, despite willingness Pathogenesis involuntary, painful reflex spasm of the paravaginal thigh adductor muscles results from anxiety about sex or pelvic exam results from a bad experience with either in the past Vaginismus is the only type of sexual dysfunction that can be diagnosed with physical exam Risk factors generalized anxiety disorder depression history of sexual trauma Presentation Symptoms pain during intercourse difficulty with vaginal penetration Physical exam pain with pelvic exam involuntary vaginal spasm during pelvic examination Evaluation Diagnosis confirmed if vaginal muscles contract involuntarily with pelvic exam Treatment Gradual vaginal dilators Physical therapy to relax the tight muscles Counseling Prognosis, Prevention, and Complications Prognosis vaginal dilators are typically very successful