The importance of recognizing the distress behind Mrs B. ‘s difficult exterior cannot be emphasized too much. If the damage that she believed that the birth had done to her body had not been explored and dealt with at that stage, she could well have continued with pain and possibly sexual difficulties for months or even years. As it was, the time taken to help her explore her own vagina and her feelings about it was time well spent. Such a patient might find it extremely difficult to pluck up the courage to come specifically to ask for help with a sexual problem, and the emotional pain would be more likely to become fixed on her perineum as time went by, even possibly leading to requests for surgical treatment. Thoughtful handling of the contraceptive consultation and a brief body/mind approach to the genital area can prevent much future distress.

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