Physicians will typically begin an evaluation by taking the patient’s medical history. Patients may be asked to complete a pain assessment. They should be prepared to answer a number of questions about pain, including:

• Has intercourse always been painful? If not, when did the pain begin?
  
  
• Is intercourse painful every time?
  
  
• At what point before, during or after intercourse does the pain begin (e.g., upon entry/penetration, during ejaculation)?
  
  
• Where does the pain occur?
  
  
• How long does the pain last?
  
  
• How strong is the pain?
  
  
• How does the pain feel (e.g., dull, sharp, steady)?
  
  
• Does anything relieve the pain (e.g., changing positions, using lubricant)?
  
  
• Is the pain accompanied by any other symptoms (e.g., genital discharge, itching, odor, burning or bleeding)?
  
  
• What medications are being taken?
  
  
• Are any other illnesses, diseases and disorders currently being treated?
  
  
• Have there been genital or pelvic infections in the past (e.g., sexually transmitted disease)?
  
  
• Has there been surgery or another procedure that could have affected the sexual organs (e.g., episiotomy, chemotherapy)?
  
  
• What forms of contraception are used?
  
  
• Does the pain occur in special situations?

Physicians may also ask a number of psychological questions, such as:

• Are there any psychological conditions?
• Was there a traumatic event (e.g., rape, child abuse) in the past?
• Has there been a significant emotional event recently?
• What is the general attitude about intercourse?
• How is the relationship with the sexual partner?

These psychological questions are necessary because sexual pain can result from mental health issues. This possibility is often considered when there is no apparent physical cause for the pain.

A physical examination will be performed. Physicians will attempt to pinpoint and re-create the pain. The exam will include palpation (feeling) of the abdomen and pelvis. This allows physicians to locate possible trigger points or areas of tenderness. The external genitalia will also be inspected for signs of lesions and other abnormalities.

For women, a cotton swab may be used probe the vagina for areas of tenderness. A pelvic examination (examination of the uterus, cervix and other pelvic organs) may also be performed. This enables physicians to look for abnormalities including fissures, erosion, ulcers and atrophy. At the end of the exam, physicians may place one hand on the abdomen and place a finger in vagina to feel the uterus and ovaries.

A rectovaginal examination, in which one finger is placed in the vagina while another is placed in the rectum, may also be performed. In some cases, the pelvic exam may be delayed until the pain is under control. Samples of vaginal discharge may be collected for pH measurements (measurements of acidity) and a wet mount (a test for vaginitis).

Men may undergo a rectal examination as well. During a prostate exam, the physician briefly inserts a lubricated, gloved finger into the rectum to feel the prostate for abnormalities, such as enlargement of the gland (benign prostatic hyperplasia) or nodules that may indicate cancer.

The physical examination enables physicians to eliminate possible causes and focus on the most likely causes of sexual pain. Depending on the type of conditions suspected, a number of additional tests may be performed, including:

• Cultures. Cervical, vaginal or prostate cultures may be taken and analyzed to look for signs of infection.
  
  
• Blood tests. Analysis of blood samples can reveal many conditions including herpes, other infections and sickle cell anemia. Regular prostate-specific antigen (PSA) tests can help in diagnosing prostate disorders.
  
  
• Urine tests. Urinalysis can reveal disorders including urinary tract infections, prostatitis and orchitis (inflammation of a testicle).
  
  
• Urethroscopy or cystoscopy. After applying local anesthetic, the physician inserts a specialized endoscope (a small tube with camera attached) through the urethra to look for blockage or other abnormalities.
  
  
• Colposcopy. A colposcope (instrument with magnifying lenses) is used to to view the cervix and vagina.
  
  
• Imaging studies. Pelvic, bladder, transrectal or transvaginal ultrasound may be performed. The physician may also order tests such as a CAT scan or MRI.
  
  

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• Allergy tests.
  
  
• Biopsy. A sample of tissue may be taken if a condition such as cancer is suspected.
  
  
• Laparoscopy. Insertion of a small lighted viewing device (laparoscope) through an incision. It may be performed to examine the pelvis for evidence of abnormalities.