Sufferers will see several doctors before a correct diagnosis is made. Women are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the time they become sexually active. Before being successfully diagnosed patients sometimes are told that the pain is "in their head". For the diagnosis doctor carefully takes a history and carefully examines the pelvis to duplicate the discomfort and to identify a site or source of the pelvic pain. The diagnosis of painful sexual act has to be differentiated from conditions known as ‘’’chronic vulvar pain’’’ and vaginismus. The pain may be acquired or lifelong. It may be generalized (complete) or situational. During the first two weeks, painful sexual acts caused by penis insertion or movement of the penis in the vagina or by deep penetration is often due to disease or injury deep within the pelvis. Inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. The possible role of psychological factors in either causing or maintaining the pain must be considered.