“Sex has become painful and I freeze — something happened to me years ago”

Sexual difficulty disclosed alongside a past sexual assault calls for trauma-informed care, and the way the disclosure is received shapes everything: respond with belief, validation and gratitude for her trust, without pressing for details she is not ready to share, and let her lead how much she says. The central principle is to go at HER pace and explicitly NOT force or rush an intimate examination — a forced or hurried exam would retraumatise her — so make clear that any examination is entirely her choice, can wait, and would only happen when she feels ready, with consent, control (she can stop at any time), a chaperone and explanation (GMC Intimate examinations and chaperones, 2024), face to face rather than on video, and only if clinically necessary; often the first consultation involves no examination at all, with trust and a plan coming first. Recognise and validate the likely trauma link: "freezing" and involuntary tightening suggest a trauma/anxiety response and/or vaginismus (involuntary pelvic-floor spasm; genito-pelvic pain/penetration disorder in DSM-5, international) with dyspareunia, a common and treatable consequence of sexual trauma, and it is a real, understandable protective response of body and mind, not a failing — a reframing that is itself therapeutic. Keep organic and contributing causes in mind (infection, lichen sclerosus, atrophy/dryness, endometriosis) to be assessed gently over time so nothing treatable is missed, without overriding the trauma-informed pace. Offer the right support — psychosexual therapy, trauma-focused psychological therapy/counselling, specialist and sexual-assault support services — with information she can take in her own time, screen current safety (NICE PH50) and mood/PTSD symptoms (NICE NG116: trauma-focused CBT, with EMDR as an option), make clear that as an adult she alone decides whether to report the assault to the police, and give realistic hope, as vaginismus and trauma responses have good treatment. The hidden agenda is hope mixed with shame, fear of judgement and the weight of a first disclosure; hand her control, make her feel safe and believed, avoid reducing her to a physical problem or pushing examination, and set a paced, supportive plan.