It's possible that your pain is caused by endometriosis, which is when the lining of the uterus, the endometrium, grows outside of the uterus -- such as in the pelvis, on the bladder or on the colon. As this extrauterine endometrial tissue is still under hormonal control, when the progesterone drops at the end of the menstrual cycle there is bleeding within the pelvis and this can cause severe pain and adhesions, which cause pain with deep thrusting. The only way to make definitive diagnosis of endometriosis is with a surgery called a laparoscopy. The laparoscopy can be used to diagnose and treat the endometriosis.
5. Do you have vulvar itching severe enough that you wake up at night scratching and you haven't gotten better with medications for a yeast infection?
It's possible that you have a vulvar skin disease such as lichen sclerosus or lichen planus. In addition to itching, these skin diseases cause chronic inflammation that can cause scarring of the vulva and vagina, which can then cause painful sex.
While some physicians make the diagnosis of these conditions just by their clinical appearance, most physicians, including Goldstein, suggest that a small skin biopsy be used to confirm the diagnosis. It is also importance to have this biopsy before treatment with any medications such as a topical steroid, because they can alter the results of the biopsy.
To find a doctor in your area who specializes in the treatment of pelvic pain, click here.
For information on physical therapy for sexual pain disorders, click here.