Sex: talking about 'it' after joint surgery

[BoneSmart]

Updated March 22, 2022 by Jamie

SEXUAL ACTIVITY GUIDELINES
Following Total Hip Replacement Surgery​

Adapted from Rancho Los Amigos Medical Center for Arthritis and Joint Implant Surgery at USC University Hospital, Patient Handbook


- Standard "Missionary" position. Both top or bottom is acceptable for female or male with THR.

- Back lying position. Suitable for female with THR.

- Front position. For female with THR lying on her operated side.

- Lower position. Appropriate for female with THR. Upper position could be used by male with THR.

- Both positions indicated for female or male with THR.

- Back lying position. Comfortable for female with THR.

- Standing position. Appropriate for either sex with THR. Support yourself by holding onto a sturdy dresser, or door frame, or bedpost.

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These positions are NOT safe for a hip replacement patient post-op:

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Here is a video done for a study that more clearly shows which positions are safe for both men and women.

Sex after hip replacement - positions

Be sure to consult your doctor BEFORE beginning sexual activities following a THR!

 

[Josephine]

WOMEN AND TOTAL HIP REPLACEMENT

What about sex after total hip replacement?

Absolutely. This is, however, an issue that many patients are shy to discuss. Available statistics demonstrate that 20 % of all patients expected an improvement of their sexual life after the total hip replacement, but studies showing how these expectations were fulfilled are still lacking.

Many women express concern about a dislocation or damage to the new hip joint while having intercourse after the total hip operation.

After 8 to 12 weeks a new capsule has grown around the new hip joint and the force has returned to the muscles around the total hip joint. Therefore, after this period the risk of dislocation is low.

Moreover, in patients who were operated on with a posterior or posterolateral access to the hip joint (the most often used operation access to the hip), the risk of total hip dislocation diminishes with the patient lying supine, the hips moderately bent and the knees apart. This is also the usual position for intercourse.

 

[Josephine]

Sex After Total Joint Replacement
Jun 5, 2009 Robin Mayhall Suite 101

With conversation, care and a little patience, it is possible for most people to return to an active sex life after joint replacement surgery.

The most common joint replacement procedures – total knee replacement, with about 300,000 operations performed each year in the United States, and total hip replacement, performed about 190,000 times, are difficult operations that carry the same risks as any other major surgery. These risks include pain, fatigue and scarring that can last for a good while after the patient comes home from the hospital – and none of those things make a person want to jump right back into sexual activity.
On the other hand, sex is a valuable part of many adults’ emotional, spiritual and even physical health. It’s a very important part of most marriages, and – let’s face it – sex feels good! Is it possible that being able to return to sex might even make a total joint recipient feel better faster?

There’s an old saying that the most important sexual organ is the brain. When it comes to both talking out the issues and being creative about sexuality, that could be true! If the joint replacement patient isn’t ready for sexual intercourse, soon after surgery, he or she might be ready for other types of intimacy. Sometimes holding one another, cuddling and kissing, watching a “naughty” movie together or pleasuring one another in other ways can bring great satisfaction to both partners.

These can be ways to ease back into sexual activity more slowly, bringing comfort back to the surgical patient and providing both partners with emotional satisfaction, too. As the patient continues to heal, the couple can try new positions and discuss other ways to return to their previous level of sexual activity.

If a previously sexually active couple is unable to return to intimacy after joint surgery, because of either partner’s physical pain or fear or emotional reluctance, they should consider going back to the surgeon for advice or a referral to a counsellor. Sometimes it takes a little expert help to overcome the hurdles of a major surgical procedure – but with patience and love, most couples will succeed.

 

[Josephine]

Sex after thr

The Sunday Times
January 21st 2006

Your letter isn’t the one I would select to boost the morale of orthopaedic surgeons. They are, by nature, jolly optimists and, so far as hip replacements are concerned, their confidence is justified. But, as in any operation, there is a small failure rate.

Your surgeons will expect their efforts to be rewarded by you having a more flexible and painless joint. This should cope with all the standard demands that you are likely to make on it, including sexual intercourse.

Younger people have hip joint replacements that have to withstand strains and loads much greater than those induced by having to bear the weight of a slim husband. The impact on the hip joint of your bedroom exercise will be small compared to that experienced by people who are intending to play golf, tennis and even cricket.

The loss of pain and tenderness that accompanies a successful hip replacement should so restore your general cheerfulness and joie de vivre that after the wounds have healed you will approach with increased enthusiasm many of the activities that may have been becoming a chore when your hip had been deteriorating.

Major surgery sometimes leaves a patient physically mutilated, or with gross scarring, but the scars of a hip replacement, even if large, are not disfiguring. Both men and women can sometimes be turned off sex if they are embarrassed about their post-operative appearance, but this shouldn’t apply to hip replacements.

Research indicates that arthritis in either partner - and your arthritis must have been severe if you are now having surgery - was even more likely to be the trigger that ended an active sex life than either of the two other common causes: loss of libido in either partner or erectile dysfunction in the male.

Immediately after surgery common sense will dictate that this is no time to explore the Kama Sutra. Once the wound has healed and your doctor has given you the all-clear to lead a normal physical life, this should also be the signal that you are able to resume your sex life. It should be as good as it was before your hip began to crumble and certainly much better than in the months that you have been waiting to go under the knife.
Initially, after you recover from the surgery, you may well prefer to give greater emphasis to foreplay. Many disabled people, and you won’t be disabled, are still able to have a satisfying sex life either as the result of oral sex or mutual masturbation without attempting penetrative intercourse.

Once you resume full sexual relations you should initially experiment with positions that won’t too much weight on your hips. The standard advice is that the various side-to-side positions, or those with the woman on top, put least pressure on her hips and are the ones that are most likely to initially be both successful and painless. If you are post-menopausal, the resumption of penetrative sex may be uncomfortable for a time. If liberal use of KY Jelly is inadequate, consult your doctor, who can prescribe hormone replacement therapy.

Recurrent dislocation of the new hip joint may occasionally complicate a hip replacement. Fortunately, this is a comparatively unusual problem, but in the unlikely event of it happening, your surgeon would give you appropriate advice. It is not a reason to avoid sex. On the contrary. Before the operation your sex life was probably compromised by joint stiffness and pain, so the increased mobility once you recover fully heralds the possibility of a much improved sex life. However, it won’t happen overnight. It takes 8 to 12 weeks for new tissue to grow around the hip joint and for the muscles in the whole area to regain their former strength, so, doctors advise that people who undergo total hip replacement and suffer no post-operative complications should wait about eight weeks before they get up to anything too strenuous in the bedroom.

Eight weeks? The average age of a hip replacement patient is 68, a time of life when any perfectly healthy female libido may need some coaxing. Throw in major surgery and it seems perfectly reasonable that a woman who is just shy of 70 may need a lengthier prescription of daytime telly and nice cups of tea before she feels ready to get up to anything too sexually athletic.

The older you get the longer it takes for any injury to heal, but recuperation is not just a physical concern. Surgery takes its toll mentally, too. Many people feel vulnerable for far longer than they anticipated and right now your most important consideration should not be whether you will, or will not, be able to support your husband’s weight but whether you are, or are not, feeling confident enough to enjoy sex just yet.

If you have any anxieties about your capacity to engage in, and enjoy, penetrative sex, then talk to your husband. He will be just as anxious not to do anything that might put undue pressure on you and your new hip. And since there are so many other ways to be intimate with each other, from kissing and cuddling to oral sex, you may want to stick to some of these until you are ready to try the vigours of penetration. When you feel ready to get back in the saddle, doctors advise that you steer clear of positions that cause too much rotation or flex your hip more than 90 degrees, so swinging from the chandeliers or doing it on the back seat of the car are out.

Use pillows and cushions to support you and start with low-impact positions such as “spoons” (you lie on the side that was operated on and he lies behind you and enters from behind), or standing positions, where you support yourself by gripping a door frame or a sturdy piece of furniture and he penetrates from behind.

Although you are worried about supporting your husband’s weight, the trusty missionary is one of the safest positions to start with (he supports his body weight with his hands while you lie with your hips moderately bent and your knees apart) as it keeps your hips at the right angle, thereby minimising the pressure on your new joint. You might also want to try lying at a 90-degree angle to him with your legs resting over his hips. As long as you are sensible you can try pretty much anything that feels comfortable, but if a position feels strained, revert to something less strenuous. Full recovery from the surgery takes about three to six months, depending on the type of surgery, your overall health and the success of rehabilitation.

That’s the bad news. The good news is that gentle exercise reduces joint pain and stiffness and increases flexibility, muscle strength and cardiovascular fitness, so a bit of horizontal jogging is, as they say, just what the doctor ordered.

 

[Josephine]

Arthritis Research
How to enjoy sex with arthritis

Will arthritis affect my sex life?
There are a number of ways that arthritis can affect your sex life:

• Arthritis can affect your mood and general wellbeing which, in turn, can affect your sex drive.
• Swollen joints can affect your self-confidence and make you feel less attractive.
• Fatigue associated with arthritis can reduce your sexual desire. Your healthcare team can advise you on ways of managing fatigue and conserving energy – more information is available in our fatigue section.
• Painful joints may make it more difficult to move into a position you’re used to.
• Arthritis sometimes leads to a dry vagina, which may make sex uncomfortable. Water-based lubricating gels such as KY Jelly or Aquagel may help. You can get these on prescription or from a pharmacy, supermarket or online. Oil-based lubricants such as Vaseline or baby oil may irritate your skin or damage condoms. If you're going through the menopause this can cause vaginal dryness – discuss this with your doctor as treatment is available.

Sex isn't equally important to all couples, but if it has been important to you and your partner then you should try to find ways to meet both your needs.

Will drugs affect my sex life?

Most drugs commonly used to treat arthritis are unlikely to affect your sex life, although steroids can sometimes reduce sexual desire or cause temporary impotence. You should discuss your medications with your doctor if you think they may be affecting you in this way.

Drugs commonly used to treat arthritis shouldn’t reduce the effectiveness of the contraceptive pill, but check with your doctor if you’re not sure.

Talk to your partner
It is not uncommon for people with a long-term illness to have low self-image, which can lessen your desire to have sex and have an impact on intimacy. If you feel self-conscious about swollen joints or other signs of arthritis, tell your partner. They may not be aware of how you feel and may have their own fears and concerns they want to talk about.

Worrying in silence can make matters worse. Talking, whether it's with your partner, your rheumatology team, or a counsellor, can help put your mind at rest.

Change your routine
Most people with arthritis find that their pain can vary from day to day, so you may want to make the most of opportunities on your better days. If you experiment with different positions, you should be able to find some that are more comfortable for your joints.

Sometimes, making little changes can make a big difference. In the same way that getting your medication right can take trial and error, changing your routine can make it easier to have a fulfilling sex life.

For example, if you find that you're too exhausted then and your pain is worse, try making love in the morning or early evening. Spontaneity is all well and good – but like many things when you have arthritis, you need to plan ahead.

Taking painkillers in the lead up to sex can help. If your joints and muscles are achy, have a warm bath to help you to relax or ask your partner to give you a massage. Before you get started, make sure you have pillows or bean bags for support to hand.

Best sex positions
Durex sex and relationship expert Susan Quilliam advises a side-by-side position, where you both lie facing and with her outer leg raised up and over his waist, means that your bodies are supported.

"Unlike the missionary position where she's underneath, or 'woman on top', it means that neither of you is taking the weight of the other.

"It's also a gentle position, that doesn't take much exertion or acrobatics, and being face-to-face makes it very intimate. The alternative side-by-side position is 'spooning', where she lies in front, he lies behind her and curled round, penetrating. This may not be as romantic but does mean that either of you can reach down and stimulate her clitoris."

Best sexual positions and tips to try
If you one or both of you has had a hip replacement or has problems with kneeling or lying face down, try a standing position. Both partners stand, with the woman resting on furniture at a comfortable height to provide support and balance, while the man enters from behind.

If you're a woman who can't bend your hips or straighten your knees, try lying on your back on the edge of the bed. Your partner then kneels on the floor and enters from in front.

Arthritis Research UK has a list of positions - illustrated with line drawings - suggesting the best positions for various problems.

When dryness is a problem
Arthritis can sometimes lead to a dry vagina, which may make sex uncomfortable. "Added to that, a woman's ability to lubricate drops naturally after the menopause, particularly if she is not using hormonal supplements," says Susan.

If dryness is a problem, Susan suggests using a water-based lubricating gel.

"I'd recommend Durex Play O which not only lubricates but also enhances orgasm. Also, make sure that foreplay is long and arousing to encourage natural lubrication. Plus, keep having sex for as long as you want it - so you don't 'lose it' because you don't 'use it', whether that's with partner sex or pleasuring yourself."

Think beyond intercourse
Sexual fulfilment doesn't have to mean penetration – using sex toys can be a way to enjoy sexual satisfaction and promote intimacy. Most toys can be bought online and delivered discreetly (in plain packaging). Even Boots and some supermarkets now have a range of vibrators.

Susan says: "If you're not used to using one, I would recommend a compact vibrator for clitoral stimulation. Because it's smaller, it can be easier to introduce into your love making."

There will be times when you just don't have the energy or the pain is too much. Try not to place too much pressure on yourself or your partner. Keep talking and sharing your feelings. Many couples find that they become closer by discussing things openly and that their relationship is stronger as a result.

Will we be able to have a baby?

There’s no reason why arthritis should prevent you from having children, but you should discuss it with your doctor before trying for a baby for the following reasons:

• Some drugs, such as sulfasalazine, can temporarily reduce the sperm count in men.
• Some studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of miscarriage if taken around the time of conception.
• Methotrexate and leflunomide can be harmful to an unborn child so need to be stopped at least three months (some doctors recommend six months) before trying to conceive. For leflunomide, you may be able to have a special 'washout' treatment to remove the drug from your body more quickly. It’s important to discuss contraception with a health professional if you're taking one of these drugs.
• Women with lupus and/or antiphospholipid syndrome may have a greater risk of miscarriage, so your condition and the pregnancy may need to be more closely monitored than usual. If you're thinking of having a baby it's best to discuss this with your rheumatology team beforehand.
• Some drugs may pass into the breast milk and could be harmful to your baby so it’s best to discuss with your doctor beforehand which drugs you can safely use if you wish to breastfeed.

Women with arthritis may find they have more discomfort in the back, hips or knees during pregnancy because of their increasing weight. Women with lupus may have flare-ups of their symptoms during pregnancy, but women with rheumatoid arthritis may find their symptoms ease while they're pregnant.

Childbirth can aggravate pain in these joints, but most women can find a position that allows them to give birth naturally.

 

[Jamie]

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