A 29-year-old woman reports pain during deep penetration in sexual intercourse, and pain seems to worsen during menstruation. She also mentions painful bowel movements during her period. What could be the cause?
The patient's symptoms of dyspareunia, especially with deep penetration, and dyschezia (painful bowel movements) during menstruation could be indicative of deep infiltrating endometriosis, a severe form of endometriosis where the endometrial-like tissue penetrates more than 5mm beneath the surface of the peritoneal cavity. Confirmation requires a careful examination and imaging, with laparoscopy as the definitive diagnosis. Treatment includes hormonal therapy, pain management, and often surgery.