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September is Healthy Aging Month

We here at Fusion Wellness PT consider pain free sex an important factor of aging healthfully! Today we talk about two common orthopedic complaints when engaging in penetrative sex: achy backs and bad hips.

Orthopedic Considerations and Penetrative Sex

As we all know, sex is an important activity for many and an important aspect of quality of life, especially as we age. In this article we’ll cover some common orthopedic issues associated with penetrative sex that people have with sex as they age and some suggestions for what you can do about it.

Back Pain

Do you avoid sex due to your back pain? Does a session of sex leave your back throbbing the next day?

Are you extension or flexion intolerant?

Go see a professional to find out what kind of back pain you have.

First of all, not all sex positions are one size fits all. Depending on the type of back injury you have and which movements aggravate it, different sex positions will be more appropriate for you. Some people get backaches with spinal flexion (like the position bending over to tie your shoe or bending forward), while others become more aggravated with spinal extension (leaning backward or arching).  Layered on top of this, some people experience more back pain with excessive movement, while others do not. Various sex positions can decrease or increase these types of movements, aggravating or allowing pain-free movement. 

This is when the help of a doctor, DO, chiropractor, physical therapist can be very helpful as they can help evaluate and assess what type of back pain you have and which motions are safe and pain free for you.

Are you giving or receiving penetration? 

Again, sex positions are not one size fits all! Whether you are giving or receiving penetration, various sex positions demand different things from your body. For those of you who do both giving and receiving penetration, its good to know which positions will work best with you depending on what you plan on doing during that session.

Positions for Receiving Penetration if you Have Back Pain

Extension-Intolerant, Receiving Penetration
If arching or extending your back increases your back pain, you are extension-intolerant. If you are receiving penetration and extension-intolerant, try the missionary position. Adding a low-back support, such as a thin pillow, can also help keep the spine in a more neutral to slightly flexed position.

Flexion-Intolerant, Receiving Penetration
For those receiving penetration who are flexion-intolerant (bending forward hurts your back), the findings suggest trying side-by-side spooning or doggy-style with the receiver supporting their upper body with their hands.

Positions for Giving Penetration if you Have Back Pain

Extension-Intolerant, Giving Penetration
For those giving penetration and extension-intolerant try missionary on elbows or side-by-side spooning.

Flexion-Intolerant, Giving Penetration
For those giving penetration who are flexion-intolerant, try doggy style with the receiver supporting their upper body on their hands. Additionally, the study recommends a hip-hinging motion rather than thrusting when penetrating, to conserve spinal movement.

Some examples of recommended sex positions based on types of low back pain are highlighted in the figure at the bottom of this article:

For more information on back pain with sex check out this previous blog post.

Hip Pain

Ongoing hip issues such as hip impingement can put a damper on your sex life. Sex can require a lot of interesting positions and hip motions, which are not always ergonomic and can add to hip pain, instability, and injury.

Avoid positions that make hips unstable

Things to avoid if you have a hip impingement or bad hips:

  • Greater than 0 degrees of hip extension (think leg going out behind you)
  • Greater than 30 degrees of external rotation (think knees pointing “out” or duck feet)
  • Greater than 30 degrees of abduction (think “spread eagle”).
  • Greater than 90 degrees of flexion (knee to chest)
  • Greater than 10 degrees of internal rotation (going “pigeon toed”)
  • Greater than 10 degrees of adduction (legs crossing midline).

Sex Positions that are Safe for Bad Hips

Giving Penetration

You will need to master a “hip hinge” movement rather than a thrusting motion.

Rear Entry positions that will keep your legs in a neutral position

  •          Spooning Side by Side
  •          Rear entry with partner on their elbows/hands
  •          Seated with partner straddling you and facing away from you

Receiving Penetration:

Rear Entry positions that will keep your legs in a neutral position

  •          Lying on your stomach (with our wihout a pillow under your hips), partner enters you from behind
  •          Lying on your belly, slightly tipped to left or right with the aide of pillows
  •          Standing with hands supported on a counter/wall, partner behind you

See more about hip impingement and sex at this blog post:



Bahouq H, Allali F, Rkain H, Hajjaj-Hassouni N. (2013). Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations. Clin Rheumatol. 32(10):1487-92

Volpe, K. (2015). Improving the Sex Lives of Patients With Chronic Pain. Practical Pain Management.

Sidorkewicz, N., McGill, SM. (2014). Male spine motion during coitus: implications for the low back pain patient. Spine (Phila Pa 1976). 39(20):1633-9

Sidorkewicz N., McGill SM. (2015). Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Eur Spine J. 24(3):513-20

Griffin DR, Dickenson EJ, O’donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016;50:1169-1176.

Morehouse, H., Sochacki, K. R., Nho, S. J., & Harris, J. D. (2020). Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. The Journal of Sexual Medicine. doi:10.1016/j.jsxm.2019.12.026 

Lee S, Frank RM, Harris J, et al. Evaluation of Sexual Function Before and After Hip Arthroscopic Surgery for Symptomatic Femoroacetabular Impingement. Am J Sports Med 2015; 43:1850-1856.

**some edits made by Heather Jeffcoat, DPT

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

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