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A 25-year-old woman presents to your office with complaints of pain during intercourse for 2 months. The pain occurs with initial penetration and continues throughout the entire episode. She relates that she and her husband have been married for a year and previously had a pleasurable, pain- free relationship. She tells you that she has been to several area doctors and had a “full work-up” without a diagnosis, including a pelvic examination, Pap smear with cultures, and pelvic sonogram. On examination, she has a normal pelvic examination with no pain. You are unsure of the differential diagnosis, so you continue taking more history. She admits to vaginal dryness and low libido during this same timeframe. You ask if anything in her life changed 2 months ago. She suddenly begins to cry and states she found evidence of her husband’s infidelity 2 months ago. What is the most appropriate recommendation for your patient?

AMarriage counseling
BEstrogen vaginal cream for vaginal dryness
CVaginal dilators for treatment of vaginismus
DAntidepressant therapy
Medicine
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