About three months ago I noticed that during intercourse I tend to have pain when I am on top. I mentioned it to my doctor, who gave me no reason for it but switched my birth control pill. I still have pain. What could be the problem?

-- Heather

There are many potential reasons for painful intercourse. Pain on initial penetration is often due to infection, spasm of the vaginal muscles or inadequate lubrication. Pain on deeper thrusting may be caused by endometriosis, adhesions (scar tissue), a retroverted (backward-tilting) uterus or fibroids. Pain in only one particular position may simply mean that in that position, your partner is pushing against your cervix.

First, if only one position is bothersome, avoid that position. If pain is more frequent and is not dependent on position, see your gynecologist for a complete evaluation. This includes a thorough history (Don't be afraid to be totally honest with your doctor. Be specific about the type of discomfort and when and how it occurs), examination, cultures to look for infection, maybe an ultrasound. Sometimes a laparoscopy is done to look for and treat endometriosis and adhesions. If your doctor does not respond to your needs, you may want to seek a second opinion and exam from another doctor.