“I have pain with intercourse. What could be wrong?”
Pain with intercourse (dyspareunia) can be caused from various reasons. Depending on what the reason is, management could be different.
Many times, pain with intercourse is caused by pelvic floor muscle spasm (Levator Myalgia). In this case, typically relaxation techniques and pelvic floor physical therapy can be helpful. In patients with prior pelvic surgery, specially when mesh is used, scar tissue can cause pain. Depending on findings during examination treatment would be different. There are also variety of gynecological reasons such as endometriosis can cause pelvic pain and dyspareunia. Interstitial cystitis also can be a reason for pain but it is mostly associated with bladder symptoms. Vaginal dryness due to menopause or lack of hormones can cause discomfort during intercourse. Various treatment options are available to improve this condition.
In summary, finding the cause for pelvic pain and dyspareunia is the most important step and can be challenging. A detailed pelvic examination and assistance of imaging such as pelvic ultrasound or CT scan as well as diagnostic tests such as cystoscopy can be helpful to find the etiology of pelvic pain.