Renata is 36 and was referred by her family physician for reduced sexual interest, present for roughly fourteen months. Her second child is now sixteen months old.

The delivery involved a second-degree perineal tear, and the repair was slow to heal. She breastfed until eleven months and describes noticeable vaginal dryness through that period. The first attempt at intercourse, at around four months postpartum, was painful and they stopped partway through. She has not attempted penetration since. She returned to work at six months, and both children still wake most nights.

She now notices herself bracing whenever penetration seems possible. A pelvic floor assessment arranged by her physician found increased resting tone. She has stopped hugging or kissing her partner outside of bed, because she does not want to give the wrong impression and then have to explain. Her partner has stopped initiating. She reads this as him losing interest in her; when asked separately, he says he did not want to add pressure.

She does not use lubricant, and says that needing it would mean something was wrong with her. She also says that if the desire were real, it would show up on its own, and that planning it would make it fake.

She grew up in a household where sex was never discussed and says everything she learned came from friends and school. She has had painful periods since adolescence, never investigated. After her first child she had a similar drop in interest that resolved on its own by around eighteen months.

She and her partner have been together eleven years and both describe the relationship as close. He has offered to attend sessions. She sought the referral herself and has already read about pelvic floor physiotherapy. Her physician took the concern seriously and referred without delay.