Let’s start with a baseline: Sex shouldn’t hurt (unless you want it to). But, unfortunately, sex does hurt for many people with vaginas. In fact, the American College of Obstetricians and Gynecologists found that three out of four people with vaginas have pain during intercourse at some time during their lives. That’s a lot of lying back and thinking of England!

But just because painful sex is common doesn’t mean every healthcare professional knows how to treat it—or even talk about it. Luckily, there are experts out there like Dr. Sonia Bahlani, aka the Pelvic Pain Doc, who are ready and willing to help.

“When it comes to painful sex, oftentimes there are multiple things playing a role at once,” Dr. Bahlani tells The Pelvic People. “There are many possible sources—and many possible treatments. That means care is multifactorial.”

So how do you even get started on the path toward receiving that care? Let’s dive in.

Step 1: The List

The very first step toward finding a solution for painful sex actually occurs before you even go to your first appointment: Dr. Bahlani recommends to all her patients that they sit down and make a list about what’s been going on.

“The answer lies in the nuances,” Dr. Bahlani says. “When did it start? Do some things make it worse? Better? Do lube or certain positions help?”

Having a clear, thought-through list not only helps the doctor get a view into what’s going on, it also helps you feel more confident talking about it during your appointment. With that in mind, here’s a list of questions to help you get started:

1. When did the pain start?
2. Did it happen once or has it happened many times?
3. Does it hurt with initial penetration? Deep penetration? Both?
4. Does lube help?
5. Do certain positions make it worse? Better?
6. Can you insert a tampon?
7. Do you have recurrent UTIs? Bacterial vaginosis (BV)?

When you’re ready to go even deeper, check out the Pain Perception Project, which is a tool Ohnut has created to help people do exactly this: Find the right words to communicate what’s going on with their doctors.

Dr. Bahlani also recommends gathering any lab work or imaging that you’ve had done with other doctors. (Assuming this isn’t your very first appointment related to this issue, of course.) Bringing that documentation to your appointment can help expedite the process, because your provider won’t have to spend time tracking everything down on their own.

Step 2: The Doctor

Once you have your list and documentation in hand, the next step is to consult your gynecologist or primary care doctor for an initial assessment. They might order further testing like pelvic ultrasounds, nerve tests, or laparoscopy to identify underlying medical causes.

“When dealing with so many factors, [it’s] always great to start with a provider who knows you,” Dr. Bahlani says. “The caveat is that many generalists are not attuned to treating painful sex and people might feel dismissed or stigmatized.”

In other words: Your doctor is a good place to start because they’re the provider who knows you best—but they might not be the provider who knows sexuality best.

That might sound a little bit scary: Most people aren’t used to talking about sex or sexual problems in a frank, open way, and here we are warning you that your doctor might not be great at it either. But, luckily, there’s an answer! Specialists!

Step 3: The Specialists

While a general practitioner might not be an expert in sexual health, there’s a whole range of other health care providers out there who are. The key to finding the right one, Dr. Bahlani says, is making sure you find someone who has a specialty in sexual health.

Here are some of the types of specialists your doc might refer you to:

• Urologists are doctors who specialize in the health of the urinary tract and male reproductive organs. They can diagnose and treat a variety of conditions that can cause painful sex (particularly for people with penises), including infections, injuries, and prostate problems.
• Sex therapists are mental health professionals who specialize in helping people with sexual concerns. They can help people understand the causes of their pain and develop strategies for coping with it.
• Pain management specialists are doctors who specialize in the treatment of pain. They can prescribe medications or recommend other treatments, such as physical therapy, to help people manage their pain.
• Mental health professionals, such as therapists, counselors, psychologists, social workers, and psychiatrists, can help people deal with the emotional and psychological aspects of painful sex. They can help people understand their feelings and develop coping mechanisms.
• Vulvovaginal specialists are doctors who specialize in the diagnosis and treatment of conditions that affect the vulva and vagina. They can diagnose and treat a variety of conditions that can cause painful sex, including infections, injuries, and hormonal imbalances.
• Urogynecologists are doctors who specialize in the health of the urinary tract and pelvic floor. They can diagnose and treat a variety of conditions that can cause painful sex in people with vaginas, including infections, injuries, and pelvic organ prolapse.
• Endometriosis specialists are doctors who specialize in the diagnosis and treatment of endometriosis. Endometriosis is a condition in which tissue similar to that which normally lines the uterus grows outside of the uterus. This tissue can cause pain, inflammation, and scarring, which can lead to painful sex.
• Pelvic floor physical therapists are physical therapists who specialize in the treatment of conditions that affect the pelvic floor. The pelvic floor is a group of muscles that support the bladder, uterus, and bowels. They can help people with painful sex by strengthening the pelvic floor muscles and teaching them how to relax these muscles, among maaaaany other things.

You can also check out the Pain Perception Project’s resource page for more links to specific provider directories if you’re trying to  track down a specialist on your own.

Step 4: The Appointment

It’s a little tricky to outline exactly how your appointment with the specialist—or specialists—will go, because it really depends on your personal circumstances, as well as who the specialist is and what they specialize in. But Dr. Bahlani has some tips for how to handle that appointment, regardless of who you’re seeing.

First: You have to find someone you feel you can really talk to.

“Trust your gut. It’s like finding the right therapist – you really want someone you can be open and honest with,” Dr. Bahlani says. “When you walk into my office, we’re really going to get into the nitty gritty. If you walk into the office and feel like this isn’t someone you can talk to, then you won’t be able to get treatment for this very personal issue.”

Next, Dr. Bahlani recommends bringing a partner or another trusted person with you. Sometimes these appointments can feel like a lot of information all at once, so having your partner there can help ensure you get all the information you need. They’re less likely to be in an emotional state about the problem, so they can take notes, ask questions, and help you process everything afterward.

And don’t be afraid to follow up!

“My office is a very open book – if you have further questions, you can always give us a buzz!” Dr. Bahlani says. “You can’t expect a patient to process everything you’re telling them in 60 minutes.”

While getting diagnosed and treated for painful sex can feel like an endless process, Dr. Bahlani emphasizes the fact that the vast majority of her patients do get better.

“By the time most people get to my office, they’ve seen multiple different providers,” Dr. Bahlani says. “They’re feeling hopeless, but there’s absolutely light at the end of the tunnel. There’s absolutely hope—over 90% of my patients live better lives.”

Sounds like pretty good odds to us. So, remember: You deserve to not only have pain-free sex but to have pleasurable sex. And there’s a whole cadre of “Dr. Bahlanis” out there who are ready to help you get there.