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.