In part 1 of this blog, we discussed reasons why your sexual health may face challenges after surgery, the general timeline for resuming sexual activity after surgery, and some tips on how to resume sex safely after surgery. This blog will discuss how to safely resume sex after surgery in more detail, including sexual positions that are safe and ones to avoid and how to monitor yourself to ensure you are able to physically tolerate sex.

Sex after surgery will be different than it was before. However surgery can improve your sex life because it can resolve the underlying condition that was interfering with your sex life (such as hip pain or knee pain). According to one study put out by a group of New York physicians, a majority of patients reported that their sex lives improved dramatically after having a hip or knee replacement.[1] Here is a quick breakdown of the study results:

  • 42% of people said their sex drive or libido improved after surgery
  • 36% of people said they could have sex for longer
  • 41% of people said they had sex more frequently
  • 55% of people had an improved sexual self-image
  • 84% of people had an improvement in general well-being
  • 90% of people had an improvement in overall sexual function[1]

In order to have sex safely after surgery, you should be aware of the safe and unsafe sexual positions for your specific surgery. In regards to hip replacement, there are two common surgery types: the anterior approach and the posterior approach. The anterior hip replacement is a hip replacement done through the front of the hip (the cut will be in the front of the hip) and a posterior hip replacement is a hip replacement done through the back of the hip (the cut will be in the back of the hip).[1][2][4]

Here Are Some Quick Tips To Have Safe Sex:[1][2][4]

  • Your surgeon will most likely give you hip or knee positions to avoid. These positions should also be avoided during sex
  • Use pillows or towels to prop you, your surgical leg, or your partner up. Take time to find a comfortable height and slowly get in and out of positions
  • Relax and stretch beforehand. Stretching before sex will improve flexibility, strength, and prepare your body for the activity
  • Don’t try too much too soon (this means no vigorous athletic sex too soon)
  • Here is a list of safe sexual positions for most patients after ACL reconstruction, anterior hip replacement, posterior hip replacement or knee replacement surgery. These positions should still be approached with caution and you should never move your hips or knees outside the limits set by your healthcare provider.

    Safe Positions for ACL Reconstruction, Knee Replacement, and Hip Replacement:[1][4]

    • Standing position for both you and your partner
    • Laying on your back such as in missionary position
    • Laying on your side with the operated leg on top
      • Pillows can be used under the knees, back, and/or side for support
    • Sitting in a chair on the bottom with your feet flat and firm on the floor

    If you have had an ACL Reconstruction or a knee replacement, sex positions should be determined by your comfort level and pain. You should also avoid kneeling and excessive knee bending. If something in the leg is hurting, do not do it.

    At Risk Positions for ACL Reconstruction:[1][4]

    • Kneeling down/being on all fours: Also known as "doggy style”
    • Stradling your partner with bent knees

    At Risk Positions for Knee Replacement:[1][4]

    • Laying on your stomach with your knees bent
    • Laying at the edge of the bed on your back with your legs dangling over
    • Kneeling down/being on all fours like “doggy style”
    • Being on top of your partner with bent knees

    If you have had hip replacement with an anterior approach you should avoid lifting your leg too far backwards and turning your foot/knee too far outwards away from your body. If you have undergone a posterior approach, you should avoid bringing your knee too close to your body and turning your foot/knee too far inwards towards your body.

    At Risk Positions for a Posterior Hip Replacement:[1]

    • Stradling your partner or sitting on top of them (too much hip bending)
    • Laying on your side with the operated leg on the bottom (too much hip twisting/pressure)
    • Laying on your stomach (too much hip bending)
    • Avoid lifting heavy objects (like your partner)
    • Kneeling on all fours which is sometimes called “doggy style”
    • Lifting or twisting your pelvis while on your back
    • Wrapping your leg over top of your partner while laying on your side

    At Risk Positions for an Anterior Hip Replacement:[1]

    • Wrapping your legs between your partner's leg while on your side

    Use Pain As Your Guide:

    Even if you are cleared by your healthcare provider to start having sex, be sure to use pain as your guide. You may feel like you have recovered from surgery, but find that pain is present when you attempt to have sex. However, in some cases, pain can be avoided with some changes to the type of positions you use, but be sure to always switch to other safe positions. Always remember to be within your pain tolerance when doing any sexual activity, otherwise it might be a sign that you should stop, especially if switching to other positions does not ease the pain.[3]

    Check out our blog on how to relieve pain after knee replacement.

    Not all sex is the same! Vigorous, athletic sex is not the ideal way to ease back into your sex life after surgery. Start slowly, and think ahead to minimize any pain or discomfort, and enjoy yourself. If you experience pain, stop and change positions or try something different.[3]

    Sex after surgery does not have to be scary. Surgery can improve your sex life. As long as you use safe sexual positions and listen to your body’s pain levels, sex can be very safe and just as satisfying as it was before or better!

    The Curovate app is an app for physical therapy that provides you with daily video physical therapy exercises, rehab reminders, progress tracking, an online physical therapist, and more, all from the convenience of your phone. Click on the links below!

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    Other recommended blogs


    1. McClure, G. (2016, May 25). Sex After a Joint Replacement: The Definitive How-To Guide. Retrieved November 22, 2020.

    2. Miles, T. A. (2016, March 21). What surgeons aren't saying about sex after hip replacement. Retrieved November 22, 2020.

    3. Whitlock, J. (2020, March 05). When is it safe to have sex after surgery? Retrieved November 22, 2020.

    4. Vancouver Coastal Health. (2017, March). Returning to Sexual Activity following Joint Replacement Surgery. Retrieved November 19, 2020.