Here are a few other causes you and your doctor may want to consider:
1. The Pill
Hormonal birth control can cause the same kind of sexual pain due to lack of lubrication and vaginal atrophy that is normally seen in postmenopausal women, says Andrew Goldstein, MD, an associate professor at George Washington University and a specialist in vulvar pain. He says he's been seeing "a ton of it" in the newer birth-control-pill formulations that have very low estrogen and a type of progestin that can lower testosterone. "I'm seeing 25-year-old women who have low desire and need lubricants, which is ridiculous!" he says.
That doesn't mean the pills are bad"for a large percentage of women, they're great," Dr. Goldstein says. But it does mean that women should be aware that there may be sexual side effects to hormonal birth control methods, which they can discuss with their doctor.
2. Cancer treatment
"For women who have cervical or vaginal cancer and radiation, the whole vagina can become a rock-hard scar," says Irwin Goldstein, MD (no relation to Andrew), director of San Diego Sexual Medicine and the editor in chief of The Journal of Sexual Medicine.
Also, "tamoxifen stops estrogen from working," Dr. Goldstein adds, so breast cancer patients can have issues with vaginal dryness and atrophy, same as postmenopausal women and some birth control pill users. It's a tough situation, because systemic hormone replacement is not an option, as it may encourage the cancer. Some doctors, meanwhile, say local estrogen is relatively safe. Other treatments may include physical therapy and sex therapy.