Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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 abnormalities of the pelvic organs, 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 (an x-ray procedure to provide an image of the urinary tract), a cystogram (an x-ray exam that images the urinary bladder), or both, or the woman may be referred to a specialist (urologist) for these procedures. Another diagnostic procedure that may be used to look for urinary abnormalities is a cystoscopy, in which the doctor uses a thin, lighted probe to see the interior lining of the bladder and urethra.