Exams and Tests

A health care provider asks about the woman's history of pain during intercourse. A thorough history and an extensive physical exam often reveal the most probable cause of this pain.

• A medical history identifying pain at the vaginal opening may suggest one of the following:
  
  
  • Inadequate lubrication during the arousal phase (may be associated with hormonal changes or medications)
    
    
  • Inflammation at the vulvar opening
    
    
  • Painful spasms of the vagina that prevent intercourse
  
  
• Pain located in the entire vaginal area may indicate conditions such as vulvar muscle degeneration, chronic vulvar pain, or a vaginal infection (fungal, parasitic, or bacterial).
  
  
  • At times, a specific area of discomfort may be identified that might suggest another cause for the pain, such as inflammation of the urethra (the tube through which urine exits the body).
    
    
  • Deep thrust pain feels to the woman as if her partner is bumping into something during thrusts. This type of pain may suggest pelvic causes, such as endometriosis, adhesions, the uterus tilting the wrong way, or sagging of the ovaries or fallopian tubes.
    
    
  • Pain in the middle of the pelvis may suggest an origin in the uterus. Pain on one or both sides of the pelvis is more suggestive of pain originating from the fallopian tubes, ovaries, and ligaments.
    
    
  
  
• A health care provider may perform an extensive physical exam of the woman's pelvis, abdomen, and lower back to better understand both her anatomy and the location of her pain. The exam may also allow the woman to better guide the doctor to the location of the discomfort. Part of this exam includes a rectal exam or rectovaginal exam. The exam may include a Pap smear, the collection of vaginal or cervical fluids for culture, an analysis of urine (urinalysis), and other laboratory tests.
  
  
• A health care provider may recommend special tests, such as a pelvic ultrasound or a CT scan or an MRI of the pelvis.
  
  
• The doctor may perform a urethrogram, a cystogram (for viewing inside the bladder), or both, or the woman may be referred to a specialist (urologist) for these procedures.