I noticed painful intercourse beginning during the same year I noted my fatigue worsening. I had post-exertional fatigue for years, and then started noticing days when I was unable to go out shopping, etc. due to fatigue. The year the fatigue began to worsen was the same year I started to notice intercourse becoming painful. I saw a specialty gynecologist who diagnosed vestibulodynia. BIHRT did not help, and topical estrogen was not effective. I have read this diagnosis can be related to "fibromyalgia", as well as mast cell issues, low NK cell activity, which also seem related to ME/CFS. Has anyone else experienced anything similar? I feel this is no "coincidence" that this condition began when my overall health started to really decline.