A 35-year old patient referred with the pain during sexual intercourse (9 out of 10 on VAS scale) that she had been experiencing for 9 years. As a result, she had completely refused to have sexual life for 7 years. She had been married for 15 years. 
The patients had previously been consulted with a gynecologist several times, but the diagnosis was not established, and she was recommended to have an appointment with a psychotherapist as gynecologists designated her pain as “fictitious”.
The patient referred to my office with a desire to get pregnant with the help of ART due to the inability to have sexual intercourse. Based on existing symptoms, the diagnosis was revealed: Chronis pelvic pain. Pelvic muscles myofascial pain syndrome. Dyspareunia.

Gynecological examination at her first appointment with me was limited to be fully performed as she had acute pain syndrome (8 out of 10 on VAS scale, and 5/3 on HADS scale) when inserting a finger. Cotton swab test was negative.Against the background of correct relaxation and abdominal breathing, it became possible to insert a finger into the vagina and assess the pelvic muscles: the coccygeal, ischiococcygeus muscles, pubococcygeus muscles/puborectalis muscles on both sides are examined, the internal obturator muscles on both sides were painful (7 out of 10 on VAS scale), compacted, palpation determined an increased pathological spasm.

At the first appointment, vaginal massage was performed by me (gynecologist) to relax pelvic muscles. The whole procedure lasted less than 5 minutes. The patient was taught the correct technique how to perform a self-massage of the pelvic muscles and exercises for relaxing them so she could do that under no supervision at home. Moreover, she was prescribed a medical treatment including Selective serotonin reuptake inhibitors (60 mg of Duloxetine daily for 3 months), and was advised to take an appointment with neurologist, psychotherapist and physiotherapist.

After 4 weeks of following these recommendations, the patient noticed a decrease in pain during sexual intercourse with her partner to 3 out 10 on VAS scale and the possibility of have regular sexual life. Seven weeks later, the patient admitted the total absence of pain during her sexual intercourse.

The correct vaginal massage, physical exercises aimed on the pelvic muscles relaxation, cognitive behavioral therapy in patients with dyspareunia caused by pelvic muscles myofascial syndrome demonstrate good efficiency. What is more, it allows to speed up the rehabilitation of the pelvic muscles and reduce the length of use of selective serotonin reuptake inhibitors to relieve pain syndrome and reduce anxiety.