Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick discusses ideas for further treatment for an individual experiencing vaginismus. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTROHey everybody, Alan here. Currently I have the pleasure of serving as the Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.com. And if you decide to make the switch, don't forget to use the code icePT1MO at sign up to receive a one month free grace period on your new Jane account. APRIL DOMINICKGood morning, everyone, and welcome to Pelvic Monday on the PT on Ice Daily Show. My name is April Dominick. I'm here to talk to you today about pain in the vag, a case study. This case study was brought to us by some of our students in our level one pelvic cohort, and they just had some questions about a case on vaginismus and where to go since they were feeling a little bit stuck. So I wanted to hop on here and provide some in-depth guidance on how to continue with what they have already started for their treatment. Particularly, they are interested in how to improve their patient's pelvic floor hypertonicity, as that's where they're feeling a little stuck. So here are some details of the case that the treating therapists have already shared with us. The subject is a 19-year-old female who's diagnosed with vaginismus. Her aggravating factors are history of difficulty and pelvic pain with insertion of a tampon. She more recently was on her menstrual cycle, got a chance to try putting the tampon in. and had another failed attempt. She also has reported pain at her inner thighs after horseback riding, and she is an avid horseback rider. Easing factors so far, the therapist had provided the patient with adductor stretching, strengthening, foam rolling, and that seems to have eased the adductor pain, not necessarily helped with her pelvic floor situation just yet. And from a physical activity standpoint, I don't know much, but again, she is an avid horseback rider. And she also reported history of sexual trauma from a horse camp instructor who is now in jail. And thankfully she is currently working with a trauma therapist as well. In terms of objective findings, again, they found some tightness and pain with adductor palpation. as well as when attempting the internal pelvic floor exam, they were limited by the patient reporting pain. Current treatment,