Surgeries such as ACL reconstruction, total knee replacement and total hip replacement are very common. What is uncommon is the discussion in health care about when a patient can safely return to sex. If you have had surgery and are wondering “when can I have sex?” But you are too embarrassed to ask, you are not alone. Statistics have shown up to 50% of women preferred to discuss their sexual difficulties with their doctors after surgery.  In addition, very few health care providers discuss this topic with their patients!
- Confidence in your body image - Surgical procedures can cause scarring.
- Emotional status - Undergoing surgery and the process of rehabilitation can be mentally challenging.
- Fear of damaging the surgical knee or hip
- Existing problems with intimacy and quality of relationship prior to surgery
However, having sex may help overcome these challenges!
When can I have sex after surgery?
- Knee replacement/ACL injuries or surgeries
- Avoid kneeling for long periods of time or repetitively for at least the first 4 months.
- With an ACL reconstruction using your patellar tendon, kneeling may remain painful for 1-2 years because of the site of the patellar graft. Modify your position and make sure you are not in pain when kneeling.
- For a knee replacement, it is possible to kneel after surgery and we have written a very useful blog about it here
- For both of these surgeries, do not affix your surgical leg on the ground and twist. Twisting and pivoting is a bad idea for at least the first 6 months.
- Hip replacement: Many but not all people who have had a hip replacement need to follow very specific movement restrictions after surgery. Stick to the postoperative movement restrictions for at least 3 months.
- Do not bring your knees over the level of your hips (Do not bend your hips past 90 degrees)
- Do not cross your legs - your surgical leg over your non-surgical leg.
- Do not twist your leg too far in or out
Your timeline for the ‘green light’ to return to sexual activities depends on your surgeon’s recommendations, your level of physical and emotional comfort, and your ability to recognize your movement and activity restrictions to protect your surgical area.
Sex can generally be resumed when the scar feels comfortable, and under the following condition:[3:1]
You should only have sex within your pain tolerance. If it hurts, change positions!
Tips for returning to sexual activities:[3:2]
- Support yourself with pillows to make sure you are in a comfortable position.
- Communicate with your partner – let them know your preference and comfort level when necessary.
- Be careful and attentive to your recent surgical area and avoid sudden movements.
- Speak to your doctor or physical therapist about when it is safe to have sex. If you are uncomfortable speaking to them, find a reliable online resource or book a virtual appointment with a medical doctor or a physical therapist. Sometimes it is easier to ask tough questions when you do not know the health care provider but you know they are qualified to give you health care advice.
Having trouble coming up with positions that comply with your movement restrictions? Here are some resources regarding sexual positions after surgery:
Patient Information Sex after Joint Replacement: Resuming Sexual Activity after Surgery by Dr. D. Naudie
Sexual function improves significantly after THR or TKR. Am J Orthop. 2013 Apr;42(4):154. ↩︎
Sex after Joint Replacement | LHSC [Internet]. [cited 2020 Nov 8]. Available from: https://www.lhsc.on.ca/joint-replacement-surgery/sex-after-joint-replacement ↩︎ ↩︎ ↩︎