Consider the following scenario: You’re about to share an intimate moment with someone special, but you start to feel sharp pain in your vaginal or pelvic area. You try to ignore the pain. It only gets worse.

When you go to see your doctor, they can’t tell you what’s wrong. They may recommend a pelvic exam and tests to try to figure out the cause. In the meantime, you’re left with more questions than answers. Does this sound familiar?

Reproductive and sexual health issues are some of the hardest conditions for doctors to diagnose in women. There are a few reasons for this. One is a lack of research into these issues. Another is the fact that many women find it embarrassing to talk about their sexual health. They may fear being judged, misdiagnosed, or accused of faking it.

But talking to your doctor about your symptoms is the first step toward finding out the cause. If answers aren’t found, then it’s time to see a specialist.

There are many common sexual health conditions that are tough to diagnose. Let’s take a closer look at why.

Endometriosis

Endometriosis occurs when your uterine tissue grows outside of your uterus, in other parts of your body, usually the pelvic area. During menstruation, this tissue reacts to hormones and grows and bleeds in the same way as the uterine tissue. However, since the tissue is outside of the uterus, it can’t shed and exit through the vagina. Instead, the tissue causes inflammation. The theory is that it can settle in other places and start new growths and inflammation. It may even lead to the accumulation of scar tissue, which can also cause pain.

Why is it hard to diagnose?

Because so many women experience painful menstruation cycles, endometriosis is one of the most difficult conditions for doctors to diagnose. The symptoms range from an upset stomach to depression. In fact, some women experience no symptoms at all. Women with no symptoms often only learn about the issue when they try to get pregnant and find they can’t. This condition has often been misdiagnosed as a digestive issue or a mental illness.

Here are the main symptoms to watch out for:

  • chronic pelvic pain (especially before and during your period)
  • pain during sex
  • cramping during bowel movements or when urinating
  • extremely heavy periods that seem to worsen over time
  • chronic exhaustion

What are the effects?

The effects of endometriosis vary from woman to woman. It’s common for women to have trouble becoming pregnant. About 40 percent of women who experience infertility also have endometriosis. In some cases, the fallopian tubes might be blocked by scar tissue.

The best way to diagnose endometriosis is through a minimal surgical procedure called a laparoscopy. The condition can be treated with pain medications, birth control, or surgery.

Vaginismus

Vaginismus is the involuntary tightening of the pelvic floor muscles. This condition can make sexual penetration nearly impossible. Vaginismus affects women of all ages. It can come about even after years of comfortable, pain-free sex.

Why is it hard to diagnose?

This condition is hard to diagnose because there are many potential physical and emotional causes. For example, there are cases in which vaginismus has been caused by tearing during childbirth or vaginal surgery. Trauma (physical and emotional) due to previous sexual abuse is another potential cause. It can also occur from a reaction to a medication, spermicides, or certain condoms. Aging can also trigger the condition.

Here are the main symptoms to watch out for:

  • burning or stinging during sex
  • difficult or impossible penetration
  • extreme discomfort when even thinking about sex
  • pain when inserting tampons or during pap tests
  • panic attacks during sex
  • muscle spasms in the back, legs, or pelvic regions

What are the effects?

Vaginismus may result when women anticipate the pain of sex and then involuntarily clench their muscles. In turn, this makes painful sex inevitable. Once the pain is reinforced, the body begins to brace itself for more pain. There are treatments that can help override this reflex. Some therapies for vaginismus can lead to a full recovery.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a hormonal condition. It causes numerous small cysts to develop within the ovaries. It’s possible for these cysts to grow larger than the ovaries themselves. As many as 20 percent of women have PCOS and don’t even know it.

Why is it hard to diagnose?

This condition is tough to diagnose because the symptoms are common for many women of reproductive age. For example, symptoms can include irregular periods, weight gain, and difficulty getting pregnant. To be diagnosed with PCOS, you must be found to have high levels of androgens, a type of hormone, in your blood stream.

Here’s a more comprehensive list of symptoms:

  • an irregular period or no period at all
  • weight gain
  • inability to get pregnant
  • hair growth in unexpected places, such as the back, face, or chest
  • acne
  • hair loss

What are the effects?

If left untreated, PCOS can potentially lead to type 2 diabetes, high cholesterol, high blood pressure, and depression. Medications can help with PCOS. Exercise and eating a healthy diet may also help.

Dysmenorrhea

Dysmenorrhea is the medical term used to describe severe menstrual pain. About 10 percent of women have this condition. There are two types: primary and secondary.

Primary dysmenorrhea refers to severe cramping during menstruation that isn’t related to an underlying condition. This is the most common type, and it usually eases as young teens mature, especially after pregnancy.

Secondary dysmenorrhea is menstrual pain that is caused by an underlying condition. It mostly effects adult women.

Why is it hard to diagnose?

Dysmenorrhea is hard to diagnose mainly because so many women have menstrual pain. It’s difficult for doctors to differentiate between regular period pain and dysmenorrhea. But women know the pain is associated with an upcoming period.

Causes of primary dysmenorrhea vary widely. Possible causes include being born with a tilted uterus, obesity, smoking, drinking alcohol, or general stress. Secondary dysmenorrhea also has many possible causes. For example, it can be caused by use of an intrauterine device (IUD) for birth control, endometriosis, a sexually transmitted infection, fibroids, or an ovarian cyst.

The main symptoms to watch out for include:

  • extreme pain in your lower abdomen during menstruation
  • sharp pelvic cramps
  • nausea
  • vomiting
  • diarrhea
  • bodily aches

What are the effects?

Dysmenorrhea can lead to general anxiety about your period. The condition can also cause stress around work and relationships. Some women feel as though they need to plan their lives around their periods. However, medication can be highly effective in treating this condition. Natural remedies, such as heating packs and massages, may help too.

Seeing your doctor

It’s a good idea to come to your doctor’s appointment prepared to discuss your symptoms. When describing your symptoms, try to be as specific as possible. Use descriptive words that will help your doctor pinpoint the issue. You might want to record details of your symptoms in relation to your periods in a journal or a chart; bringing this with you to your appointment can help you to be more accurate.

It’s common to be nervous when talking to your doctor about sexual health issues. Remember, your doctor is there to help, not judge.

The takeaway

You’re the best judge of your body. If you’re experiencing pain or discomfort, it might be time for a visit to your doctor. If you wait, you may need to deal with the symptoms for longer. Instead, seeking medical advice can help you get the care you need.