I have had extreme pain with intercourse for almost 9 years. Although several doctors have told me I'm fine, I don't think I am. The problem is a bulging feeling at the opening of the vagina. This area is painful after intercourse, and the pain is really bad if I spend a lot of time on my feet. One doctor about 7 years ago suggested a prolapsed uterus as a possible cause. What do you think?

--Terri

An examination is really necessary in order to make a diagnosis, but I can give you a few ideas. Uterine prolapse (the uterus falling down due to weakness of its supporting structures) is certainly one possibility. Often during intercourse, the penis will impact on the cervix, and this is much more pronounced -- and painful -- if the cervix is sitting low in the vagina.

It's also possible that your bladder may be dropping (this is called a cystocele), which can be uncomfortable during intercourse. With each of these possibilities, being on your feet for a long time would make matters worse; in short, gravity takes its toll.

There are many other reasons for painful intercourse, including endometriosis, adhesions (scar tissue), interstitial cystitis (a bladder condition), and ovarian cysts. Infections also can cause discomfort at the vaginal opening.

A thorough and careful history and physical exam are mandatory in trying to figure out what is causing these problems for you. Part of the exam may include a pelvic exam with you standing up. Why standing? Well, sometimes when we do the exam with you in the stirrups, the dropping of the uterus and/or bladder may not appear to be significant, but if you stand up -- well, then we can really see and feel things dropping.

A concerned physician who will listen to you and do a complete and careful exam should be able to help. Don't give up -- there is treatment available for all the conditions I mentioned. A visit to your doctor is in order to rule out anything serious. You should maken an appointment with your doctor for an exam and have this taken care of. Nine years is too long to walk around with the same problem.