An 18-year-old woman presents for a routine follow-up at a general practice clinic. She is generally healthy, an active member of her school's volleyball team, and denies any significant recent illnesses. During the physical examination, the physician observes several faded linear abrasions and faint contusions on her upper arms, along with a few small, circular marks on her inner thighs that resemble minor burns. When gently inquired about these findings, the patient hesitates slightly before explaining that these marks are related to her sexual activities, stating, "My boyfriend and I… sometimes we get really into it. I need things like being hit or having pressure on my neck, or even feeling a little pain, to truly get aroused." She describes a committed, monogamous relationship with her live-in boyfriend. While she expresses satisfaction with her relationship, she mentions having grown distant from some friends because "they tend to overreact about my choices, so I just keep to myself more." She is academically driven, preparing for law school, and works part-time. The remainder of her history and physical examination is unremarkable. Given these findings, which of the following is the most likely diagnosis and the crucial initial management step?

A 30-year-old woman presents to a specialized women's health clinic reporting persistent, severe pain during attempted vaginal intercourse over the past year. She states that while she experiences desire and emotional intimacy with her partner, the pain begins immediately upon any attempt at penetration, making coitus impossible. She describes the pain as a sharp, tearing sensation, often accompanied by an involuntary tightening of the pelvic muscles, despite her conscious effort to relax. Her medical history is unremarkable, with no prior surgeries or chronic conditions, and she denies any history of sexual trauma or abuse. She has tried lubricants without success. Vital signs are stable: temperature 36.8°C, blood pressure 118/76 mmHg, pulse 88/min, respirations 16/min. Physical examination of the external genitalia reveals no lesions, erythema, or signs of infection. Upon gentle palpation of the vestibule, she reports mild discomfort but no significant tenderness. During an attempt at speculum examination, she exhibits marked muscle guarding and apprehension, though the speculum can eventually be inserted without causing the severe pain she experiences with intercourse. Bimanual examination is deferred due to patient discomfort and guarding, but previous records from a routine check-up two years prior indicated normal uterine and adnexal findings. What is the most likely diagnosis and the most appropriate initial management strategy for this patient?

A 7-year-old boy is brought to an outpatient clinic by his paternal grandmother, who is his primary caregiver. He was recently suspended from school for engaging in inappropriate sexual behavior, specifically exposing himself and attempting to touch the genitals of another student on the playground. The grandmother expresses concern, stating that he has also become increasingly withdrawn at home and exhibits sudden outbursts of anger, a noticeable change from his usual calm demeanor. She mentions that his mother recently moved out of the household due to financial difficulties and a new job opportunity in another city. The family had previously been living in a shelter for a brief period before securing their current temporary housing. On physical examination, the boy appears well-nourished and cooperative, though somewhat subdued. His temperature is 36.9°C, blood pressure is 98/55 mmHg, pulse is 78/min, respirations are 18/min, and oxygen saturation is 98% on room air. No immediate signs of trauma or external injury are noted upon a brief, non-invasive assessment. Which of the following represents the most likely underlying diagnosis and the most appropriate initial management strategy?

A 20-year-old female university student presents to a specialized sexual assault crisis center approximately three hours after an alleged sexual assault. She reports having been returning to her dormitory from a study session when she was forcibly accosted by an acquaintance. She is visibly distressed, speaking in a low, trembling voice, and often averts her gaze. She expresses a strong desire for immediate medical evaluation, including testing for pregnancy and sexually transmitted infections. Her medical history is unremarkable, with no known chronic conditions or psychiatric diagnoses. Physical examination reveals multiple scattered ecchymoses of varying sizes on her upper extremities and anterior torso, alongside fresh linear abrasions on her wrists and ankles. A focused anogenital examination reveals perivulvar erythema and superficial mucosal abrasions, with minimal active bleeding. Her vital signs are stable, but she exhibits a guarded posture and appears to be in a state of acute emotional shock. Given her presentation, what is the most appropriate initial management strategy, and what long-term psychiatric complication should she be immediately screened for?