When Physician asks: Are you sexually active?
 Are you having any sexual difficulties at this time?
 Without shy or hesitation, it is advised to discuss with physician the problems relating to sexuality, personal relationships, contraception, and fears of pregnancy etc.

What is Dyspareunia?
It means – difficult as well as painful coitus.
Causes of Dyspareunia ?
Painful intercourse may be caused by vulvovaginitis; vaginismus; an incompletely stretched hymen; insufficient lubrication of the vagina; vaginal atrophy; endometriosis; tumors; other pathological conditions.
VULVOVAGINITIS: Is inflammation or infection of the vagina.  Areas of marked tenderness in the vulvar vestibule without visible inflammation occasionally show lesions resembling small condylomas on colposcopy.
REMNANTS OF THE HYMEN: The hymen is usually adequately stretched during initial intercourse, so that pain does not occur subsequently.  In some women, the pain of initial intercourse may produce vaginismus.  In others, a thin or thickened rim or partial rim of hymen remains after several episodes of intercourse, causing pain.

DRYNESS OF VAGINA / INSUFFICIENT LUBTRICATION / VAGINAL ATROPHY:
With decreased estrogen secretion, thinning of the vaginal mucosa and decreased vaginal lubrication occur and may lead to painful intercourse.

INFECTION, ENDOMETRIOSIS, TUMORS, OR OTHER PATHOLOGIC CONDITIONS: Pain occurring with deep thrusting during coitus is usually due to acute or chronic infection of the cervix, uterus, or adnexa, endometriosis, adnexal tumors or adhesions resulting from prior pelvic disease or operation. A large tender Bartholin’s cyst is occasionally obstructive to entry.

DUE TO UNKNOWN CAUSES:
The patient may have psychosexual conflicts or a history of  childhood sexual abuse.

DUE TO MALE PARTNER:
Gross congenital abnormality of the penis.
Impotence, usually partial, eg. Failure to maintain an erection long enough for penetration.
Premature ejaculation.
Complete and surprising ignorance in the technique of coitus.

CLINICALLY DYSPAREUNIA IS DIVIDED INTO:
1.    Superficial: The pain occurs when penetration is attempted and the causative lesion is therefore to be expected at or near the introitus.
2.     Deep seated, when the pain is not associated with penetration but is felt only after this has occurred and is usually localized in the depth of the vagina. It is usually organic and is associated with ovarian pathology such as prolapsed and tender ovaries in association with retroversion, endometriosis or chronic pelvic inflammatory disease.
3.    Postcoital dyspareunia, a less well known entity, sometimes associated with the deep seated variety.  Here the patient complains of an aching soreness which lasts for several hours after the completion of the act.

What are the  investigations?: It is advised to get physical examination by the physician and required ultrasonic scanning, Hormonal test etc.
Why HOMEOPATHY ?: Homeopathy has very wide scope in the treatment of Dyspareunia and it can address 90% of the causative factors of this disorder.