Background: The onset of unexplained dyspareunia with a normal pelvic examination requires a careful evaluation to search for an etiology.
Cases: The initiation of Kegel exercises led to dyspareunia in several patients whose pain could be localized to the levator ani muscles. Elimination of the muscular overexertion led to resolution of the dyspareunia in all cases.
Conclusion: Dyspareunia associated with the initiation of Kegel exercises may be due to levator ani myalgia. Once recognized as a potential source of dyspareunia, levator myalgia is easy to diagnose and treat.