Pain during sex when you are on top

Pain during sex when on top may result from depth, angle, dryness, pelvic-floor tension, or a condition needing assessment. This position can give you more control, so use that control to stop, change depth, or change position as soon as discomfort starts.

Deep aching or a sharp internal pain may be related to pressure against pelvic structures, including with Endometriosis or an Ovarian Endometrioma. Burning at the entrance may relate to friction, Vulvodynia, or Lichen Sclerosus. Pelvic Inflammatory Disease can also cause pelvic pain. None of these can be diagnosed from position alone.

Stay upright or lean forward, keep movement shallow, and use your hands for support if that feels comfortable. Lubricant can help when friction or dryness is present. Take a break if pain continues, and avoid products with fragrance around the vulva. Note whether the pain is at the entrance or deeper, and whether it follows a menstrual pattern.

Arrange a review if the problem keeps happening, appears outside sex, or is accompanied by discharge, bleeding, itching, urinary symptoms, or period-related pelvic pain. Seek urgent medical help for severe pain, fever, fainting, vomiting, heavy bleeding, or sudden deterioration. You deserve an examination that is explained and consent-led.

Could the pain be from pelvic muscles, dryness, infection, or deeper pelvic tissue? Would an examination, swab, or imaging test help? Which changes should I try before sexual activity again?