Disability may affect muscles and joints in the back, hips, knees, and hands - body parts that are involved in the experience of sex, pleasure, and intimacy. As every person’s body and experience of disability is different, the effect on sexual positioning may vary from mild to significant. This guide offers some basic suggestions for sexual positioning for women with physical disabilities. The sexual positions can be done with a partner or by using a sex toy or adaptive device.
Pelvic Floor Positioning
- Weakened muscles in the pelvic floor can negatively impact intimacy and sexual pleasure for many women.
- Fears of losing bowel and bladder control can make it extremely difficult for a woman to feel comfortable in an intimate and/or sexual relationship.1
Helpful Tips about Positions for Sexual Intimacy and Bowel/Bladder Control
- When you sit, the contents of your intestines rest on your pelvic floor, putting pressure on your bladder and rectum.
- It is harder to control your bladder and bowel with this pressure, so the IDEAL position would be lying with your hips raised slightly (view below).
Other Things to Consider
- Lying on your side can help the abdominal contents move off your pelvic floor.
- Does your chair tilt? If yes, it may help to tilt back slightly as this will help with pressure on your pelvic floor.
- Do you have spasticity or muscle spasms? If so, work with pillows to support your legs, arms, and other parts of your body to ease spasticity, as it can lead to fatigue
Helpful Items for Positioning
Pillows: pillows can be placed under the legs, behind the back, under the stomach and other places depending on what position the woman is using. Add pillows to different parts of the body for comfort and stability. (See types of positions below).
Wedge: the wedge gives a similar support as a pillow but much firmer. (See types of positions below).
(Image description: there are two images. The first is a light blue and gray pillow wedge. It is narrow on the bottom and increases in height from one side to the other at a 45° angle. The second image is similar, but the color is red with a black zipper. This image has a second wedge pillow that is the same shape but smaller and is set at the bottom of the wedge. The tapered ends of the two wedges are facing one another.
Ankle Cuff with Leg Strap: this device assists in holding the legs to help alleviate fatigue. (See types of positions below).
Image description: a black circular cuff that has a VELCRO-like self fastener on the outside to open and close the cuff. There are two circular rings. One ring is to thread the material through to tighten or loosen around the ankle securing with the self fastener. The second circular ring is to attach another cuff or belt.
Types of Positions
In the adaptive missionary position, the woman with a disability will lie on her back on the bed with her buttocks as close to the edge of the bed as possible. Her partner will stand between the legs of the woman with limited mobility, facing the bed. The partner who is standing will then lift their partner’s legs, so the ankles are resting on the shoulders of the partner. This also allows for easy penetration while reducing the risk of pressure on the back, associated back pain, and muscle spasms in the woman with mobility limitations. This position can also be used with a strap-on dildo. In addition, a wedge or pillow can be placed behind the head or neck of the woman with limited mobility, as well as under the lower back to help decrease lower back pain. Additional pillow placement can assist in different positioning for penetration.
Modified Doggie Style
With the modified doggie style, the woman with a disability will lie on her stomach on the bed placing a wedge under her lower abdomen with the high point of the wedge at the bikini line. She will lie facing down with her head at the edge of the wedge. This allows for her buttocks to be higher in the air than the rest of her body, creating better access to the anal and vaginal regions. Pillows can be used to prop legs and keep them from moving outward or sliding. Her partner can now penetrate or enter from behind. This is a position that can be used with a strap-on dildo, and it also provides access for finger penetration.
The spooning position can be used by people of all abilities. It is especially helpful for individuals who have back pain, limited mobility, arthritis, or fibromyalgia.2 This position involves little movement and limited pressure on the joints. One partner will lie on their side on the bed, slightly curved. The other partner will lie directly behind their partner. This position allows both partners to have their hands free to stimulate areas on themselves or their partner, as well as allowing for easy penile or finger penetration, both vaginally and anally, from behind. This is also a position that can be used with a strap-on dildo.
The Sideways 69 position can be used by people of all abilities, but especially for those with weak or spastic hips. One partner will lie on their side on the bed in the “spooning” position while the other partner will lie facing them with their head at the opposite end. This allows both individuals to freely stimulate each other with their mouth, tongue, fingers, and sex toys.
In addition to positioning, some individuals also find that including sex toys can powerfully impact helping to achieve what they may want for their sex lives. For more information, visit our Self Pleasuring (Masturbation) page.
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- Beers L. Living with Muscular Dystrophy: Sexual Education: College of Social and Behavioral Sciences, Walden University Online; 2018.
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