A 35-year-old female presents with deep pain during intercourse, especially in certain positions. She has a history of endometriosis. What are the possible causes and what are the next steps?
Deep dyspareunia (pain during intercourse) in a patient with a history of endometriosis could indicate that the disease has progressed or returned if she was previously treated. Other causes could be pelvic inflammatory disease or uterine fibroids. A pelvic examination and ultrasound would be useful initial steps, and gynecology consultation may be needed.