1. Endometriosis; sometimes with chocolate cysts
2. Uterine fibroids
3. PID or pelvic inflammatory disease
4. Vaginal dryness due to menopause; child birth; breastfeeding; medications or too little arousal before sexual intercourse with lack of lubrication.
5. Vaginitis
6. After hysterectomy in some cases or any pelvic surgery.
7. Skin disorders leading to ulcers; cracks; itching or burning; herpetic eruptions. 
8. Infections like sexually transmitted diseases; yeast infections or urinary tract infection.
9. Anatomical defects like a vaginal septum; and abnormally shaped uterus
10. Injury or trauma from child birth; episiotomy.
11. Radiation therapy

1. Stress;
2. Improper arousal before the sexual act starts.
3. Fear; guilt or shame related to sexual intercourse.
4. Medications like birth control pills
5. Relationship problems and depression.
6. Past history of sexual abuse or rape.

All these conditions lead to loss of arousal and dyspareunia.

Symptoms of Dyspareunia

1. Pain during penetration
2. Pain during or after intercourse.
3. Deep pain in the pelvis during sexual intercourse.
4. Burning; itching; aching or stabbing pain or menstrual cramp like pain during sexual intercourse.

What to Expect During Your Visit to Your Gynecologist

Your doctor will take detailed history and the questions include:

1. 1. When and where do you feel the pain?
   2. How is the pain? Sharp; stabbing; unbearable or diffuse?
   3. Do you get the pain at time of penetration; during intercourse or after the intercourse?
   4. Do any other activities also cause the pain?
   5. Do you get severe pain during the menses also?
   6. Physical examination

1. Pelvic ultrasound
2. Urine routine test
3. Vaginal swab testing for culture to test for bacterial or yeast infection.
4. CT scan or MRI to determine the exact cause if needed.

Treatment of Dyspareunia

1. Medicines: It includes antibiotics; antifungals; and other medications
2. HRT: or hormonal replacement therapy  if the vaginal dryness is due to menopause
3. Local lubricants if the dryness is purely due to lack of lubrication.
4. Surgery: If dyspareunia is due to fibroids; chocolate cysts or endometriosis.
5. Consulting with a sexologist can help you get rid of nonphysical causes for dyspareunia.

Home Care for Dyspareunia

1. Use water soluble lubricants
2. Relax before starting the sexual activities.
3. You can take simple painkiller half an hour before the sexual activity.
4. If it burns after sex; apply ice pack