Psychosexual Disorder

Option List:
A. Triple swabs, urinary pregnancy test, and pelvic and abdominal ultrasound scan 
B. Tricycling with COC for 6 months, then review
C. Ectopic pregnancy
D. Abdominal and pelvic examination
E. Triple swabs
F. Irritable bowel syndrome
G. Serum β-hCG estimation and laparoscopy
H. Serum Ca-125 and β-hCG estimation, FBC, CRP
I. Serum β-hCG estimation, and pelvic and abdominal ultrasound scan
J. Pelvic and abdominal ultrasound scan
K. Serum β-hCG estimation
L. Endometriosis
M. GnRh analogue 4 weekly X three doses, then review
N. Serum Ca-125 estimation, and pelvic and abdominal ultrasound scan
O. Polycystic ovary syndrome
P. High fibre diet and Mebeverine for 2 months, then review
Q. Laparoscopy
R. Laparoscopy to exclude pelvic disease
S. Referral for psychosexual counselling
T. Fitz-Hugh-Curtis syndrome
You have been given scenario related to psychosexual disorder . It’s a progressive scenarios where   You are Required to answer specific questions asked from the options given above .

Ms. Tina ,A 29-year-old P2+0 lady presents to the clinic with a history of deep dyspareunia for last  months.  Her last menstrual period was 10 weeks ago. 
She also complains of bloating of her abdomen, abdominal pain and occasional diarrhoea for last 6 months. 
Obsteric history 
Her first delivery was normal delivery at home 
Her second delivery -
She had a  rotational forceps delivery  for persistent occipito Posterior with episiotomy 3 years ago. 
She was diagnosed to have polycystic ovary syndrome 14 months ago following investigations for infrequent periods and  excessive weight gain. 
Subsequently, she split with her  both boyfriend s7 months ago and stopped using any contraception. 
She has been in a same-sex relationship for last 4  months with her secretary Alice.


1. Now she has presented to your clinic with above complaints. What would the most appropriate initial step would be
2. She was examined with consent and in front  of chaperone. The abdomen was found to be bloated with tenderness in the left lumbar area and iliac fossa; 
Local examination -Episotomy scar -no redness  or no tenderness.
The posterior and left fornices were tender on vaginal examination. 
What would the relevant investigations be?
3. What would the most likely diagnosis for her deep dyspareunia be?
4. What would the most appropriate management be?