Abstract
A high-functioning, 45-year-old married woman's complaint of difficulty and pain with intercourse was found to be due her having a vagina only half the normal size, a condition the patient was unaware of despite 25 years of sexual activity, regular gynecological care, and previous sex therapy. Unraveling how the patient had kept herself from knowing this revealed pathological psychological defenses—defenses that also prevented her from making a good accommodation to her situation once she learned of it. A combination of sex therapy and psychotherapy was used in the treatment.