Infertility: vaginismus: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Infertility: vaginismus

Sample item

A newly married 24-year-old woman cannot permit vaginal penetration because of involuntary spasm of the pelvic muscles and fear of pain. Pelvic anatomy is normal. What is the most appropriate management?

ALong-term sedativesBHysteroscopyCPsychosexual counselling with graded vaginal dilatation and pelvic floor relaxationDSurgical hymenectomy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Psychosexual counselling with graded vaginal dilatation and pelvic floor relaxation

Vaginismus is a conditioned involuntary spasm related to anxiety, and it responds to education, counselling and gradual desensitisation using dilators. Surgery has no place when anatomy is normal. Treating it also restores the possibility of conception.

Option by option

A. Long-term sedatives
Sedatives do not cure the condition and cause dependence.
B. Hysteroscopy
Hysteroscopy is not relevant since no intrauterine pathology is suspected.
C. Psychosexual counselling with graded vaginal dilatation and pelvic floor relaxation (correct)
Correct. Graded desensitisation with counselling is first-line.
D. Surgical hymenectomy
Surgery does not address the muscle spasm or fear.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Psychosexual counselling with graded vaginal dilatation and pelvic floor relaxation. Vaginismus is a conditioned involuntary spasm related to anxiety, and it responds to education, counselling and gradual desensitisation using dilators.

Why is "Long-term sedatives" not the answer?

Sedatives do not cure the condition and cause dependence.

Why is "Hysteroscopy" not the answer?

Hysteroscopy is not relevant since no intrauterine pathology is suspected.

Why is "Surgical hymenectomy" not the answer?

Surgery does not address the muscle spasm or fear.

What concept does this question test?

It tests Infertility: vaginismus in OBG. Surgery has no place when anatomy is normal. Treating it also restores the possibility of conception.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infertility: vaginismus?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.