Sometimes, if you are suffering from chronic or acute joint or muscular pain, sex can be unpleasant, difficult, or even impossible. The pain of getting into the right position, thrusting, and moving in a natural rhythm with your partner increases existing discomfort. For people suffering from these conditions, sex might not seem worth it.

To us, that’s unacceptable.  

When pain outweighs the pleasure of sex, couples can lose intimacy and become frustrated with themselves or their partners, which can lead to other relationship struggles. It’s a real problem; a pulled back from lifting something wrong in the yard can have rippling effects throughout a relationship.

Pain is bad enough. Pain that inhibits sex is a multiplying disaster. That’s why we’re so happy to offer these tips and alternative positions to reduce discomfort.

None of these will cure pain, or even lower it in day-to-day life. For that you need your doctor. But these are ways you can manage pain, or work around it, so that you and your partner can have the healthy sex life that you deserve.

Medical Notes

There are occasions where your doctor tells you not to have sex, or that excessive physical action will be bad and exacerbate your chronic or acute pain. None of these tips are meant to circumvent that. If they don’t work, or they are painful, don’t do them. These are just ideas that you can practice if pain makes sex difficult.

These tips are just for joint, back, or arthritis pain. They are not recommendations for people suffering from dyspareunia, pelvic pain, vaginal pain, penile pain, or pain caused by STDs. If facing any of those, learn more and see your doctor.

Readers with specific disabilities may find some of these joint and muscle pain tips to be helpful, but for more disability-specific advice, please check out our page on sex toys and positions for people with disabilities.

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Want to have a little bit of good pain during sex? Learn more about BDSM.

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Remember: Sex Isn’t Only About Penetration

There is something weird about how there is “sex,” but then also “oral sex,” “non-penetrative sex,” “manual sex,” etc... As if sex can only be one thing, and everything else is a variation in a minor key, or somehow lesser. That isn’t true.

Sex can be what you and your partner want to do together, and it doesn’t have to fit into a narrow category. If you are having a lot of trouble moving, making thrusting penetrative sex too difficult, that doesn’t mean you have to forsake intimacy.

Other options include:

Experimenting with oral. Use ice, whipped cream, lickable lube, or other new oral sensations. Put a blindfold on the recipient. Losing sight heightens other senses, and makes it even more exciting (though let’s face it; oral is already pretty exciting).

Mutual masturbation. Helping your partner get off by talking dirty, sharing fantasies, or rubbing them while they pleasure themselves can not only be sexy exciting fun, but can make you feel more comfortable opening up verbally.

Using a vibrator. A lot of times we think of using a vibrator just for masturbating, but using it on your partner can be extremely intimate. Women know that a vibrator can be her best friend, but using one on a man’s sensitive parts can also be extremely surprising and erotic.  

Using anal beads. We’ve long touted the pleasures of pegging, but you can also enjoy anal play without thrusting. Anal beads can be a great way to pleasure your partner (doubly so if they want to be restrained… you can come up with a lot of fun scenarios).

Initial Tips to Reduce Pain

There are ways to reduce pain before you have sex, or to prepare your body for action before intercourse. You won’t always have the luxury of planning these in advance, but if you do, they can help make sex less painful and more pleasurable.

• Take a warm bath. This will relax your muscles, leaving you looser and less tense. Less rigidity puts less pressure on your joints.
• Stretch out beforehand. Stretching is always a good idea when you have pain, especially before having sex, which often puts you in some unusual positions.
• Gather more pillows. These can be used under your back or butt to alter the way you’re lying. This can be very good for your back and knees, depending on the position.
• Mediation also relaxes your mind and body both.
• Plan in advance the positions you are going to do, and talk about it with your partner. Because in the heat of the moment, your rational brain isn’t always working, and you may think: I can totally do this reverse doggie-style double screwdriver! We’re not saying you have to have a script, but have in the back of your mind which positions you’ll be wanting to do—or wanting to avoid.  

So which positions are the best for you? Well, it depends on what kind of pain you have. Let’s break it down.

Sexual Positions for Different Types of Chronic and Acute Pain

In a wide variety of positions, positioning toys can ease stress on joints by adjusting leverage or moving weight around. These toys can be helpful for many positions, including those we’re going to discuss below.  Feel free to use them as you see fit. These are guides, not rules.

 Best Positioning Sex Toys For Reducing Discomfort

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Sex Positions for Back Pain

At any given moment, 31 million Americans are suffering back pain. 80% will have back pain at some point or other in their lives. Should that eliminate sex for every one of these people? Of course not. Try these positions.

Spooning. Spooning is great because you are both lying on your side, and the “big spoon” is just using their hips to thrust.

Edge of the bed. One partner is lying face-up on the edge of the bed, with their knees dangling over the side, so the other can stand in front and enter them that way. This is great for either party with a bad back, since the receiver won’t have any extra weight on them and the other party can keep their back straight.

Standing against the wall. Another ideal position for keeping a straight back. Standing isn’t always the easiest, depending on height, but using a suction foot rest attached to the wall can make it easier, and door jam cuffs can provide some extra stability.

Cowgirl/reverse cowgirl. If the woman has a bad back, being on top works out great for her. She doesn’t have any weight on her, and can control the motion. Also, it’s a fun and exciting position.

On a chair. If the man has a bad back, he can sit in a hard-backed chair, keeping his back straight and supported. His partner will straddle him, hanging onto his shoulders or the back of the chair.

On their stomach. As we know, doggie style is difficult if either or both parties have a balky back. That’s why a modified sort of doggie style works great. If one partner is lying on their stomach, and the other lies on top, penetrating from behind, neither back has to experience excess bending or curving.  

For more information on sex for those with bad backs, read our Best Sex Positions (Or Toys) For Back Pain or Injury.

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Sex Positions for Knee Pain

After backs, knees are the most common form of pain, with over 100 million Americans reporting knee pain at some point in their lives. It may be an injury, arthritis, or you may have just wanged it on the edge of the bed. Whatever the cause, it doesn’t have to end or postpone your sex life.

Missionary. Missionary has a boring rep, but it doesn’t have to. It is incredibly intimate, and if the bottom partner has bad knees, it can alleviate a lot of pressure.

Cowgirl/Reverse cowgirl. If the man has bad knees, the woman being on top is a godsend (one that feels awesome as well). He can participate as much as possible, including hip thrusts, or lie back and let her take charge.

Bent over the bed. Want doggie style without getting on your knees? Go to the edge of the bed (or table or desk or whatever) and bend over it, letting your partner enter you from behind. For some people, standing puts too much pressure on the knees, but for others, being able to stand with knees slightly bent, while not having to do much movement one way or the other, takes the pressure off.

In the morning! Sure, this isn’t actually a position, but knee pain tends to be less severe in the morning. If this is the case for you, stop thinking about sex as a purely nighttime activity. Start to have more intercourse in the morning. It might take some adjustments to your schedule, and maybe your mentality, but sex is just as good in the morning as it is at night.

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Sex Positions for Hip Pain

Hip pain and damage can get gradually worse throughout life, and hip replacements are getting more common. Between 2000 and 2010, the number of hip replacements for Americans over 45 more than doubled, and as the procedure gets more advanced, it becomes more common.

It isn’t the end of anything, and people with hip replacements lead long active lives. But pain or replacement may require some sexual modifications and different positions.

Side by side. This is like reverse spooning where you are lying on your side, but facing each other. It will require some adjustments of the legs, but it necessitates only a very gentle thrusting, more coming from the butt than the hips, and is extremely intimate.

Spooning. Same as side-by-side, of course (except back-to-front), with little-to-no pressure on the hips.

Kneeling at edge of bed. If the woman has hip issues, she can kneel at the end of the bed, elevating her hips and taking them out of the equation. The knees are doing most of the work, and the man, standing, enters from behind. For him, standing means the ability to thrust from the knees, taking some of the pressure off his hips as well.

Perpendicular. Imagine a “+” where the intersection is at your groin. The two partners intertwine their legs, with the woman lying on her back, and the man on an angle to enter her. The angle already has unusual and exciting sensations, and the thrusting comes from the man moving his legs.

For more information on sex for those with hip pain, read our 6 Tips for Enjoyable (and Safe!) Sex After Hip Replacement Surgery.

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Sex Positions for Arthritis/Osteoarthritis

Here’s a bit of good news: it turns out that sex can actually help relieve arthritis! But that doesn’t mean it is always easy to do so. Arthritis, which can affect every joint, makes it more difficult to move, to thrust, or to grip, all of which can be vital for sex.

But, if you want to use sex to get better, or just have sex because, well, it is awesome, arthritis doesn’t have to stop you.

Since arthritis can impact your back, legs, knees, or hips (as well as arms and other joints, though those may not apply as much to sexual positioning tips), any of the above positions that correlate with your particular pain should work. Try what works for you.

For more information on sex for those with arthritis, read our Positions and Toys that Let You Have Exciting Sex Regardless of Your Arthritis post.

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Make Sex Pleasurable For Both Of You

Our guiding advice is: do what works. Don’t think that you have to have sex the same way, and don’t think that the above positions are the only ones you can do. Experiment. Play around with angles and toys. Modify any positions you want.

After all, no one’s pain is exactly like anyone else’s… and no one’s sex life is exactly like anyone else’s—nor should it be! You and your partner have your own intimacy, your own secrets, your own private games and pleasures, your own favored positions. These might change to different degrees because of pain, but the intimacy and love behind them don’t have to.

Expand your ideas of sex. Change up your routines. Change your ideas. Pain isn’t the end of sex. It’s a call for more innovation. We’re glad to help.