Mia is 33 years old and for the past 10 years she has suffered pain at the entrance to her vagina when having sex. She was very frightened when she arrived at the psychosexual clinic, didn't want to take off her coat, and sat with her bag on her knee ready to leave any minute. She was annoyed that her general practitioner (GP) had asked her to see a ‘head doctor’ and felt she just needs to be ‘sorted’ so that her partner can have sex with her. When the doctor told Mia that she was a gynaecologist, Mia burst into tears and told the doctor that she had been seen by six gynaecologists and had five operations so far: three to look into her womb and two to widen the entrance to her vagina, as well as several injections into her vagina. She had been given instruments to help her dilate her vaginal entrance, which she hated using and which caused her a lot of pain, even though she had been told the gel was an anaesthetic (so it wouldn't hurt). She also felt humiliated having to use them.
The pain she felt was so severe that she couldn't have sex with her partner who, although he loved her, had said he was no longer sure that his future is with her. They had stopped trying to achieve penetration as it was ‘hopeless’, and they were more like ‘brother and sister’ than romantic partners. She was extremely angry about the failure of her treatments to date, but remained convinced of a physical problem, saying it felt like there was a ‘wall that stops him from getting in’.
On the examination couch, she drew her knees up and the cover to her chin. The doctor told her that the examination could wait and that Mia was ‘in control’ of the situation. She relaxed and allowed a finger in. Then she asked, ‘What's it like … in there?’
The doctor asked if she would like to touch her vaginal area to find out. At first, Mia recoiled from the suggestion, but eventually she tentatively touched herself and remarked that it felt warm and safe.