Sex & Relationships

Why It Hurts When You’re On Top During Sex & What To Do About It

A pelvic floor therapist unpacks the pain.

by Chika Ekemezie
miodrag ignjatovic/E+/Getty Images

Picture this: It’s August 2020. WAP has just been released, and for the next few days, Cardi B’s words are reverberating through your mind. “Hop on top. I wanna ride. I do a kegel while it’s inside.” While not the most accurate depiction of what sex can feel like, this track put on full display all the different, messy, and fun ways we can have sex with our partners (or ourselves). But for many people with vulvas, having sex on top of their partners can lead to pain rather than pleasure.

According to Dr. Samantha DuFlo, or Dr. Sam, a pelvic floor therapist who specializes in treating pelvic pain, there are a variety of reasons why someone may be experiencing pain during sex while on top of their partners. Some may be physiological, such as fibroids or endometriosis, which are disorders that cause growths to grow either outside (endometriosis) or inside (fibroids) the uterus. Pelvic floor muscle issues can also spark pain — so, please consult a doctor before performing Kegels, contrary to what Cardi B says.

Not to worry — although sex can sometimes be uncomfortable when you’re on top, there are steps you and your partner can take to make it more comfortable.

Why Pain During Sex On Top Happens

First things first: Dr. Sam says it’s incredibly important that you warm-up for sex, just like any other form of physical activity. When you’re on top, you’re using your glutes and your leg muscles to control your movement. If those muscles are tight or inflexible, it can be uncomfortable to maintain that position for longer than a few minutes. Dr. Sam says that when those muscles aren’t strong enough or when you start to gas out, a person with a vulva may involuntarily over-tighten their pelvic floor muscles, which can lead to pain.

Pain could also boil down to the logistics of being on top. Think about it: For vagina owners, when you’re on top, your partner is able to get way up inside of you. Your body is bearing all its weight on theirs. Your partner’s depth may feel great if deep penetration is how you get off, but for other people, this can be uncomfortable or downright painful. And Dr. Sam says that, in some cases, this position can cause your partner to accidentally tap your cervix. The feeling of someone tapping or even bruising your cervix can range from the sensation of mild period cramps to intense, sharp pain.

What You Can Do About The Pain

Since the root cause of the pain may be different for everyone, there isn’t a one-size-fits-all solution. For example, Dr. Sam says that if the issue is related to a tight pelvic floor, she wouldn’t recommend doing a bunch of glute exercises. But there are some key tricks you can try to make being on top work for you and your body. Make sure you’re feeling turned on before you get on top, as a means of creating natural lubrication (aka “wetness) and mitigating pain while having sex. “When a human being that has a vagina is aroused, it will actually lengthen the vaginal canal to accommodate something like a penis or something the size of a penis,” Dr. Sam says. “If you’re having sex and you’re not aroused and fearing the onset of pain, it can affect your body’s ability to accommodate penetration, which then causes more pain.”

Dr. Sam also advises that you warm up to being on top rather than riding from the get-go. This will help your body feel prepared for a position that can require a little more physical effort on your part. So, try having sex in positions that you know are comfortable for you first. If you feel like you lose stamina quickly in this position, you can try strengthening your quads and glutes. Exercises like squats, deadlifts, and glute bridges target the muscles that you’re engaging while you’re on top. Making them a regular part of your routine may help. If flexibility is the issue, try yoga! Yoga is a great way to prepare your body for sex. I feel like some yoga poses already feel like you’re going through the motions, and Dr. Sam says positions like a deep squat or chair pose can help prep your hips for being on top.

If you want to make being on top work for you, it’s important that you pinpoint the root cause of your pain. Try to narrow down the specific location of the pain, or identify when during sex it starts to hurt (Does it hurt when your partner first enters you? Are you starting to cramp up a couple of minutes after riding?) If it’s a matter of endurance, focus on that. If it’s strength, work on your butt muscles and thighs.

One more thing to consider: the way your body reacts to sex can sometimes be connected to your mind. Not to say that it’s all in your head, but factors like stress, anxiety, or past sexual trauma can cause your body to react to sex in ways that cause pain. Working with a therapist to talk through the underlying reasons could go a long way in helping sex feel better for you.

Other Positions You Can Try

If being on top doesn’t work for your body, you can also try different positions that don’t stress your lower half. Dr. Sam says that lying on your stomach or side is always a good go-to. These positions can help sex feel more comfortable because they slacken your pelvic floor muscles and allow more room for your partner to enter you.

Suppose none of these tips or alternate positions work, and sex continues to hurt. In that case, whether you’re on top or not, it might be worth speaking to your gynecologist to see if it’s another issue that requires additional attention. You might also consider a pelvic floor therapist, like Dr. Sam, who will work with you to identify the cause of your pain and give you exercises that can address them. To find the right pelvic floor therapist, you want to look for one that spends a ton of one-on-one time with you and specializes in both strengthening your pelvic floor and pelvic floor pain, as well as one that has experience working with patients like yourself. (For example, I’m a powerlifter, and there are pelvic floor PTs that specialize in working with powerlifters.) Or a cognitive behavioral therapist might be able to work with you to address some of the mental triggers that are causing sex to be painful while you’re on top.

I know that any feelings of pain while you’re having sex can be scary. People tend to think of sex as a wham-bam, thank-you-ma’am operation, so anything that feels like an outlier can throw you off your game, both physically and mentally. But it’s super important to listen to your body, communicate with your partner, and, if possible, consult with an expert you trust to address the root causes. You never have to suffer in silence or just hope that the pain goes away.


Dr. Sam, pelvic floor therapist specializing in treating pelvic pain