New version: (Click Here)

Prepare for your medical exam, USMLE, MCCEE with a FREE MCQs and clinical cases! ECG, CXR and all types of free medical MCQs with answers, good luck! Medical MCQs from students to students.

A 22-year-old nulliparous woman has recently become sexually active. She consults you because of painful coitus, with the pain located at the vaginal introitus. It is accompanied by painful involuntary contraction of the pelvic muscles. Other than confirmation of these findings, the pelvic examination is normal. Of the following, what is the most common cause of this condition?

  1. Endometriosis

  2. Psychogenic causes

  3. Bartholin’s gland abscess

  4. Vulvar atrophy

  5. Ovarian cyst 


in Ob/Gyn by

1 Answer

0 votes
Best answer
b. Psychogenic causes. (Mishell, 3/e, pp 179–182.)

This patient presents with vaginismus, defined as involuntary painful spasm of the pelvic muscles and vaginal outlet. It is usually psychogenic. It should be differentiated from frigidity, which implies lack of sexual desire, and dyspareunia, which is defined as pelvic and/or back pain or other discomfort associated with sexual activity. Dyspareunia is frequently associated with pelvic pathology such as endometriosis, pelvic adhesions, or ovarian neoplasms. The pain of vaginismus may be psychogenic in origin, or may be caused by pelvic pathology such as adhesions, endometriosis, or leiomyomas. Treatment of vaginismus is primarily psychotherapeutic, as organic vulvar or pelvic causes (such as atrophy, Bartholin’s gland cyst, or abscess) are very rare.