With Physical Restrictions, Sex May Change But It Doesn’t Have to End

Don’t worry — physical restrictions like a hip replacement, colostomy bag, or arthritis don’t need to spell the end of your sex life. In fact, sexual health experts say, these restrictions, whether temporary or permanent, are an invitation to bring play into your life.

“Remember the first time you experienced intimacy with your partner or you experienced sex with yourself, how fun that exploratory phase was?” says Maya Green, MD, chief medical officer at Howard Brown Health. “You have another shot at exploring again. It’s time to celebrate. You’re actually gaining the opportunity to explore in that area.”

Often when people face a new health condition, be it knee replacement surgery or a spinal cord injury, they may not be able to have penetrative sex in the same way as before. That could cause them to believe sex is no longer an option for them, Green says. “In truth, this is a chance to explore different styles and positions during sex. As long as everyone present is on board, sex is definitely still an option.”

“[Sex is] a journey that we adjust during our lifetimes based on what our bodies’ needs are and based on what our gratification needs are at that time,” Green says. Our bodies and health change throughout our life, “so does our sex life, for everybody at every level of ability,” she says.

Other experts agree. “There’s virtually no physical situation that cannot have some kind of a modification so people can enjoy sexual activity,” says Lauren Streicher, MD, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

That said, if your physical restriction is still new, sexual activity may not be your top priority, but that can change. “When someone’s learned they have life-threatening cancer, most don’t really care that their sex life is on hold for the moment,” says Streicher, author of multiple books including Sex Rx: Hormones, Health, and Your Best Sex Ever. Later on, they may care, so “it’s good to know that there are solutions,” she says.

Modifications for sex with physical restrictions

Just how do you engage in sexual activity if you are physically restricted? There are infinite possibilities, says Heather Howard, PhD, a board-certified sexologist in San Francisco and creator of Ergœrotics, a wellness model that applies the science of ergonomics to sexual activity to promote comfortable sexual pleasure.

Modification strategies for sex with physical restrictions vary depending on an individual’s health conditions and abilities, as well as their preferences and fit with their partners. Howard and other sexual health experts offer these tips to prevent pain and promote pleasure:

Joint-protection strategies

• Listen to your body: Respect pain as a signal to stop whatever it is you’re doing. Don’t force any movement.
• Don’t twist the joint: Move in the natural plane of your joints. And move slowly so you can stop if you need to change a movement.
• Plan ahead: Think about how you’ll get in and out of a position before you move into it. You may want to practice by yourself so you can get comfortable with your body at your own speed, or do a dress rehearsal with your partner before playtime.

Strategies for specific health conditions

• After hip replacement surgery: Depending on the type of surgery you had, your surgeon may advise you to avoid movements such as crossing your legs or bringing your knees closer than 90 degrees to your chest to prevent dislocation.
• After knee replacement surgery: If you’ve recently had surgery, choose positions that avoid putting direct pressure on your knee or require significant bending of your knee. Listen to your body, and let pain be your guide.
• If you have back pain: Work with your physical therapist to determine your directional preference, which is the direction or range of movement that is most comfortable. Then you can modify your positions and movement strategies accordingly. For example, if bending backward is painful, use positions that avoid back bends.
• If you have pelvic pain: Pelvic muscle tension and fear of pain can increase your discomfort. To feel safer and more relaxed with penetration, find positions that allow for muscle relaxation.

Intimacy accessories to support your body

• Furniture: You can buy furniture, such as chairs or chaise lounges, specially designed as physical supports for sexual activity. You can also look around your house and see how you can use your furniture to support sexual activity.
• Pillows: Pillows in varying sizes can make solo or partnered sexual activity more comfortable when you have physical restrictions. They can be used supportively in a variety of ways, such as behind your back, under your buttocks, between your knees, or under your abdomen.
• Harnesses: These are available for use on a variety of body parts. For example, if you have arthritis in your hands or cerebral palsy, a hand harness can help you hold a vibrator or dildo.
• Everyday items: Consider repurposing household items to help make sexual activity more comfortable, such as using heating pads or a heated blanket to relax tense muscles.

Communication strategies

• With your medical providers: If your doctor doesn’t feel comfortable or knowledgeable enough to have a conversation about sexual activity, ask for a referral to someone who does, such as a sexologist — a specialist in sexuality. Physical therapists are good resources because they consider how to safely adapt movements. When you talk to your provider, be specific. For example, you can ask, “After surgery, at what point can I have penetrative sex?” Or, “Do you think I can do X position with my back problem?”
• With your partner: Be straightforward about your physical limitations and suggest alternatives. You could say, for example, “That position is uncomfortable for me. How about if we try this position?” Look for resources, such as sexual health educational videos, that discuss how to approach positions and other forms of pleasure.

There are endless modification possibilities, but the most important adaptation happens in your mind. “The mind can be the most limiting factor when it comes to sex — not the body,” Howard says. “The brain can go places where bodies can’t go.”

In other words, let your imagination run wild and take you places you thought you might never go with the body you have.