Dyspareunia is the term used to describe painful intercourse. It is classically described as being 'superficial dyspareunia' when it is felt on the outside of the vagina or 'deep dyspareunia' when it is felt deep inside the pelvis.
Superficial dyspareunia can be caused by vulval problems such as pruritis vulvae and vulval dystrophy as well as vulval cancer (but rarely) . Other vaginal infections or inbalance of vaginal flora can also be associated with superficial dyspareunia such as thrush and bacterial vaginosis. Atrophic vaginitis can also cause superficial dyspareunia.
Causes of deep dyspareunia include endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, and pelvic congestion.
Standard investigations of dyspareunia include tests for sexually transmitted diseases, swabs for other vaginal infections, a vaginal ultrasound scan and a laparoscopy.