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Pain-Free Sex Positions for People 50+

As you age, your go-to sexual positions might not be as comfortable anymore. Experts say it might be time to rethink your sex moves

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Allie Sullberg

After years of smooth sailing in the bedroom, lately sex might not be feeling as great. You may be recovering from a recent injury, chronic pain could be flaring up or a condition like arthritis might be causing newfound joint stiffness. Then there are all the hormonal changes we go through as we get older, like dropping testosterone levels or vaginal dryness thanks to menopause.

“There are many reasons that sex can start to be less enjoyable as we age,” says Heather Jeffcoat, president of the Academy of Pelvic Health Physical Therapy and author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve. But if you’re willing, making a few tweaks doesn’t have to put a damper on your sex life.

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And with less than half of older Americans reporting that their sex life is satisfying, according to a 2023 AARP survey on sex, those modifications might be the key to a better sex life overall.

Here’s a guide to finding comfortable and enjoyable sex in your 50s and beyond.​

Ease up on your joints

Positions that minimize joint stress such as lying side by side can reduce discomfort in those with conditions like arthritis, says Kien Vuu, M.D., a triple board-certified physician and the author of Thrive State. And spooning positions can feel better for people with back pain, especially for the partner doing the majority of the work.

Maybe you used to love being on top in missionary position or often defaulted to doggy style, for example. But now you have osteoarthritis in your knee or are recovering from knee replacement surgery, so kneeling or being on all fours doesn’t feel good these days.

In this case, you may need to restrict your range of motion and avoid direct weight on the knees; try positions that involve standing or lying on your back instead, says Heather S. Howard, a board-certified sexologist and the founder of the Center for Sexual Health and Rehabilitation.

One cautionary note: Don’t try to push through the pain, says Kourtney Randsdorp, owner of Functional Freedom, a mobile physical and occupational therapy company that serves Lancaster County, Pennsylvania, and “listen to your body,” she says. Howard warns that if you continue to have sex in a position that doesn’t feel great, eventually your nervous system may begin to expect pain, and you’ll either tense up, which can lead to additional pain, or start to avoid sex altogether.

Swap positions with your partner

If you have mobility issues, you may benefit from positions in which your partner is the more active participant, says Randsdorp.

This could be doggy style, with your partner in the standing role and you resting on all fours on the bed. You could also engage in person-on-top sex and prop yourself up with a pillow at a comfortable angle to be the individual who is lying on the bed. And in missionary position, the person on their back is doing a lot less work.

Props, sex furniture can support your achy body parts

When you sit on the couch, do you put a pillow behind your back for added comfort? Translate that mentality into the bedroom with sex furniture and props. “Many of the sexual positions that we enjoy in our youth can be achieved in later adulthood with the assistance of props — such as physical therapy wedges and blocks, straps, and pillows — to decrease the amount of athleticism required,” says Jeffcoat.

Use pillows to help you get into a comfortable position by elevating your hips or providing extra padding behind your back. You can also use a small pillow to pad sore knees, like you would during kneeling yoga poses.

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 You can visit an adult store — there are options in person and online — to purchase furniture and pillows designed specifically for people with mobility challenges, says Howard.

Sex accessories geared toward older adults may also help, says Lauren Streicher, medical director of education and community outreach for Midi Health, a virtual care clinic for women’s midlife health, and founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

Relaxing positions can help with sexual dysfunction

In postmenopausal women, vaginal dryness can be a big concern. And for older men, so can erectile dysfunction (6 in 10 men said they had trouble getting an erection, according to the AARP survey).

If vaginal penetration is still desired, the key is to position your body so that you have good pelvic alignment, which will minimize rubbing the vaginal entrance, says Howard. For instance, you can modify missionary style by sliding a pillow underneath your lower back to raise and stabilize your pelvis, which can make insertion easier for women who are feeling dry down below.

Engaging in an intimate but relaxing position such as spooning can take the pressure off too, says Vuu. “These positions can help reduce anxiety related to ED by fostering emotional connection and reducing the need for sustained physical exertion, which can be challenging in the presence of ED,” he says. 

You can also support your partner by encouraging them to visit a physician to discuss a variety of treatment options such as prescription medications and hormone replacement therapy. 

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Have a sex rehearsal to try out your new positions

Don’t wait until the moment of passion to try a new position. Have a little fun with a dress rehearsal with your clothes on first, says Howard.

“Try it together to figure out how you get in and out of a position, how you might move or what cushions you need,” she says. That way when you’re excited and in the moment, you know you have that position as an option.

The practice session can be enjoyable all on its own, adds Howard, “because it’s like a game of Twister — you’re trying to figure out something together.”

If you try out a new position or are attempting to modify a previous favorite one, know that it may not work perfectly on the first round. It may take a few attempts to figure out how to make the position work for you. “Don’t get discouraged,” says Howard.

Anything new is a learning process, she says, as it was when we were first learning to be physically intimate with early partners. “And it’s totally normal for it to be awkward or to not be able to figure it out the first time around,” adds Howard. Hang in there and you’ll find what works best for you.

Still at a loss for what positions will help? Ask an expert.

Experts in different fields can help you not only communicate better with your partner as to what feels good but also offer practical tips tailored to your conditions.

A sexual counselor can help you communicate. There are professionals who specialize in all things sex, from the emotional aspects to the physical side of things. This guidance, Howard says, “can help individuals and partners improve self-image and communication, identify what pleasurable activities are possible with the bodies they have, and adjust to new activities as their bodies change or improve with medical care.”

Find online resources to spark discussions. You can also use articles like this one or videos like Howard’s Ergoerotic series, in which she shares position modifications for various types of pain, as launching pads for such conversations. She suggests bringing any informative materials you find online to your partner and talk about ways you can work together to pain-proof your sex life.

See a physician or physical therapist. Your physician can be a great person to talk to.

“Let your doctor know that sex is important to you,” says Howard, “because then they can try to help give you resources. And if they don’t have them, then you can ask for a physical therapist.”

A physical therapist who specializes in pelvic pain, for instance, can help you map out what specifically is causing your pain: the act of penetration, friction in a certain position or other causes Then they can suggest modifications or positions to try that can help you be intimate without aggravating those areas. 

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