In most cases, painful sexual acts have a physical cause at first. There are many physical problems that can cause or worsen painful sexual act. A doctor may be able to identify the cause by doing a careful physical examination and medical history. Some of the most common physical causes are infections of the vagina, urinary tract, cervix, or fallopian tubes; endometriosis; scar tissue left by surgery (like an episiotomy); and ovarian cysts and tumors. Common infections are mycoses (infections caused by a fungus), candidiasis, chlamydia, trichomoniasis, urinary tract infections, coliform bacteria, monilial organisms and herpes). Painful sexual act can also be caused by problems with a woman's anatomy, like hymenal remnants (pieces of the hymen that stay in the vagina) or female genital mutilation, or when the entrance to the vagina has become too small for normal penetration (Sarrell and Sarrell 1989).