Introduction: Sometimes couples refer with complaints of long-term infertility, while their main problem is vaginismus and inability to have  intercourse. This study reports the treatment of a patient with severe lifelong vaginismus using a cognitive-behavioral approach.
Case presentation: The couple with a history of 18 years of marriage, childless, had requested the use of assisted reproductive techniques for having a child. At first visit, due to the woman's inability to perform the vaginal examination and the history of fear of intercourse, they were referred to the sexual health clinic for treatment of vaginismus. The woman had a history of hymenectomy under anesthesia, which was ineffective in resolving the problem. Woman's anxiety and embarrassment of expressing the problem, her reluctance of treatment with a male doctor, and the husband's fear of having child due to the death of his mother during childbirth were the factors in the persistence of vasinismus during these years. The 18 years vaginismus was resolved with cognitive-behavioral therapy in less than 3 months. Spontaneous pregnancy occurred 3 months after treatment of vaginismus.
Conclusion: Taking an accurate sexual history and encouraging the couple to treat vaginismus prevents invasive assisted reproductive techniques. Prolonged vaginismus should not cause the couple and the therapist to be disappointed with the treatment. The happy and hopefull mood of the therapist in the counseling session, having patience and calmness, designing the treatment in accordance with the couple's lifestyle, paying attention to the husband's feelings and gaining his companionship in the treatment and promoting couple's self-confidence and self-management are among the success factors of vaginismus treatment. Also, continuous follow-up and giving positive feedback to the patient in cyberspace will speed up and continue the treatment process.