When poet William Cowper said, “Variety’s the very spice of life, that gives it all its flavor,” he may very well have been talking about the bedroom.
A little (or a lot) of variety can make sex more fun and pleasurable, but when a physical condition makes certain positions challenging or painful, finding safe, creative alternatives is important.
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As you explore different positions, keep in mind that sex should never be painful, says Megan Fleming, Ph.D., a sex and relationships therapist in New York City.
“Too often, I hear of partners who grin and bear it because they believe their partner is close to climax,” she says. “This is a bad idea, because you will be reinforcing negative sensations and feelings about sex.”
Knowing they’ve caused you pain or discomfort can also be a turnoff for your partner as well, she adds.
To make sure you and your partner get the most out of your time in the bedroom (or whichever room you choose!), here are some experts tips on different positions to try:
Positions for an Aching Back
Back pain is the No. 2 reason for doctor visits, according to the American Chiropractic Association. But that doesn’t mean it has to keep you from satisfying sex. If you're the one with back pain, avoid positions that put pressure on the spine, such as missionary position with you on the bottom.
“The partner who doesn’t have back pain should be taking the active role [with the] most physical exertion,” says Fleming.
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Lie on your sides in a spooning position, she suggests. Either one of you can take the front role, or you can switch off, stimulating each other where it counts with a toy, your hands or your genitals. You can also flip into a “69” position on your sides so you can both give and receive pleasure at the same time.
Bad Knee? Take a Seat
Knee pain is another notoriously common ailment that can really put a damper on your sex life. If you have a bad knee, avoid positions that put pressure on your knees, such as “doggy style” or you on top.
For men with knee pain, Fleming says, a favorite is sitting on a chair and having their partner on their lap, facing forward or away from them. For women with knee pain, lying on their stomach or on their backs in missionary style is a good way to avoid knee strain — and everyone can benefit from the spooning position!
Hips Don't Lie
“Different versions of missionary are fabulous for someone with a bad hip,” said Kait Scalisi, M.P.H., a sex and relationship educator in New York City. “It’s easy to make sure the hips are supported and aligned.”
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Her recommended variation is the coital alignment technique, because it also provides the clitoral stimulation that many women need in order to orgasm.
“The person on the bottom lies with their legs straight and the back, hips and knees supported with pillows as needed,” she explains.
“The person on top lies with their legs open on either side of the other person’s. They support their weight evenly on their forearms, elbows, thighs and upper knees, again using a pillow wherever needed. Then the person on top slides their body upwards so your pelvises align.” Then, rather than thrusting forward and back, rock up and down.
For a Pain in the Neck
If you’re experiencing neck pain from a chronic condition or something as simple as sleeping awkwardly, avoid positions like being on the bottom in missionary. “Being on top is a great option here if you can easily hold your head up,” says Scalisi.
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Spooning is another great option, she says, because you can use pillows to support your neck, head and shoulders. It’s also more challenging to move quickly in this position, so there may be less jostling. If you’re not in the mood to lie fully down, go for doggy style.
“The person on bottom can support their chest and neck with pillows,” says Scalisi. “And rather than have their partner thrust — again you want to avoid that jostling which could tweak the neck in a not-fun way — they can push back on to them and/or rotate their hips around them.”
Woman on Top
In her practice, Heather Jeffcoat, D.P.T., a Los Angeles physical therapist and author of "Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve," sees cases of vaginismus and interstitial cystitis — conditions that make sex painful for many women.
Vaginismus causes involuntary muscle spasms around the vagina, while interstitial cystitis means recurring pain or discomfort in the bladder and surrounding pelvic area.
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With these and all sexual-pain disorders, Jeffcoat recommends avoiding the missionary position. Instead, start with the woman who is experiencing pelvic pain on top. This allows her to control the speed and depth of penetration.
“Many women are also more comfortable in a side-lying position with rear vaginal entry,” Jeffcoat adds.
Positions for Pregnant Moms
While it’s wise to check with your doctor, most women can continue having sex throughout their pregnancy. Amniotic fluid in the womb and the mucus plug, which seals your cervix and staves off infections, protect the baby.
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“The only position to avoid when pregnant is missionary after 20 weeks, because a woman’s enlarged uterus puts pressure on her aorta,” says Fleming, “which could compromise blood flow to the placenta.”
If missionary is your favorite, adapt it by wedging a pillow under your left hip, she says, which helps shift the baby off the aorta. Otherwise, stick to positions like doggy style and spooning.
Sometimes Size Does Matter...
When you’re well-endowed in the penis department, ample foreplay is extremely important for your partner’s comfort, says Fleming. You may even want to add some external lubricant for easier penetration.
Go for positions in which your partner can control pacing and depth of penetration. And while there’s no need to completely avoid certain positions in this situation, make sure to use plenty of lubrication for anal sex and anything from behind.
... But Not All the Time
The answer to the ongoing debate, “Does size matter?” is … not really. How you maneuver your manhood is what counts.
So, if you're on the smaller side, guys, then it's all about the angles. “Positions and angles really matter,” says Fleming. “A woman’s G-spot is around three inches inside of her anterior vaginal wall.”
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If you want to reach the G-spot with deeper penetration, try doggy style. This also allows your partner to squeeze her legs together around you for more sensation.
Avoid positions in which her legs are fully open — without the ability to squeeze them — and positions that don’t allow you or your partner to use hands or a toy to stimulate her clitoris.
Positions for a Small Vagina
A particularly small or tight vaginal opening is usually a symptom of treatable muscular spasms known as vaginismus — or, in rare cases, other medical conditions.
That said, if you’re able to have sex, Fleming suggests positions in which you can control pacing and depth of penetration. You on top after plenty of foreplay or 69 may be good picks. Limit positions in which you have less control, such as you on the bottom.
Positions for Larger Body Size
Much like penis size, overall body size is a common source of sexual insecurity. But regardless of shape and size, everyone deserves (and can have) a gratifying sex life.
Focus on relaxation, sensation and what you find attractive about your partner, rather than personal insecurities, says Fleming. This will help you stay present and enjoy sexy play, instead of becoming more of a distracted observer.
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Because endurance and stamina can be an issue for people with excess weight, Fleming recommends positions that require less energy, such as spooning and doggy style. If you’re the heavier one, avoid positions that place much of your weight on your partner — such as you on top without bracing yourself up on your arms and knees.
Too Tall or Too Short?
A hefty height disparity between you and your partner shouldn’t mean a pleasure shortage.
Missionary is a good option for working around height differences, according to Scalisi, because it puts the person on top in charge of alignment. “Some version of doggy style is also fabulous,” she says. “One partner can kneel or lie on a bed while the other stands, or you can stand on a stool and lean against the wall or bend over a couch, etc.”
In addition to experimenting with various positions, timing is an important thing to consider: “Most people with pain have windows where they have more energy and less discomfort,” says Fleming.
Mornings may be a bad time for sex if you have arthritis, for example, while a night of rest may make morning sex ideal if you’re experiencing back pain.
If you take daily pain medications, plan sexy play during windows of maximum relief. Warming up your muscles with foreplay, light stretching or a warm bath or shower before sex can also help minimize pain and strain.
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No matter what your condition, don’t be afraid to use props like pillows and rolled-up towels. “I like to think of it as props in yoga,” says Scalisi. “They help you get into the positions more deeply and more aligned so you can fully reap all their benefits!”
Lastly, think beyond penetration. Whether you’re dealing with pain, discomfort or size differences, keep in mind that sex isn’t merely about penetration: Your hands, mouths and toys can go a long way to enhance pleasure and intimacy for both you and your partner.
What Do YOU Think?
Have you ever abstained from sex because of a physical condition? Have any other creative positions that we left out? Any other advice for people whose conditions limit their action in the bedroom? Leave a comment below and let us know!
August McLaughlin is a health and sexuality writer, podcast host and author of “Girl Boner: The Good Girl’s Guide to Sexual Empowerment” (Amberjack Publishing, 2018). Her articles appear in DAME Magazine, Cosmopolitan.com, the Huffington Post and more, and she loves connecting with readers through her blog and social media. augustmclaughlin.com