Ask a Cleveland Sex Therapist: Finding the Right Positions as We Age

Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.

I am an older woman (50s) who has been in a relationship going on 13 years. We had an extremely sexual relationship, but it slowed down right before I had a hysterectomy, then stopped altogether. Since then, I have developed arthritis in my hip, been diagnosed with scoliosis and gained about 50 lbs. I am doing my best to get my weight down, but the arthritis is here to stay. My question is this: what are some sexual positions that we could do that take into account my health issues? I admit I have some concerns about initiating anything and not being able to follow through. I know that the libido for both of us has slowed down, but it’s not gone. And I am aware of mutual masturbation, but that was never turn on for him. Any suggestions would be welcome. Even if you tell me things I probably already know. At least it will be coming from an expert!
– NS

Hey NS! Thanks for writing in and sharing some of your story. It is encouraging to hear that you are not ready to throw in the towel on sex and intimacy with your partner. We often here that sex is going to fade in long term relationships and once it does, it is gone forever. This is usually the point where people start throwing around the word “sacrifice” when talking about relationships. You know the line: “You have to sacrifice to make a relationship work, otherwise, you’ll end up alone.”

I am pretty sure every television show in the 90s and early 2000s said this at some point. Let me pop in my DVD of Desperate Housewives and I’ll get right back to you. I was just telling a client the other day, imagine if we grew up in a world where sex wasn’t feared or shamed? I wonder what that world would look like. Probably one where people aren’t told to just “sacrifice” their sex lives once the spark starts to fade or things get tough. It sounds like a lot has shifted for you over the years, NS. So, let’s take a moment to explore how sex and intimacy can evolve with you, because it doesn’t have to wither away.

When I read your question, a couple of go-to positions came to mind right away. But before we dive into those, we’ve got to talk about what items you might want to bring into the bedroom. Sex toys, or sex “tools” as we say in the sex therapy community, are a game-changer at any age, but especially as our bodies start to age and need a little more support or stimulation. If I hear one more person say they want to have sex without any toys, “all natural,” I am going to hurl. These toys were created as a way to enhance pleasure, not be in competition. Each and every person’s body, especially vulva-owners, is different and requires different levers to be pulled for us to have an orgasm. Although I tell everyone that an orgasm is not the be all end all of a sexual encounter, it is fun when it happens, and these toys are here to help. My hope, NS, is that we can start incorporating some of these tools so that some pressure can be taken off both you and your partner.

Another item we want to start incorporating already exists in your bedroom (I hope): a pillow. Pillows might not be marketed as sex tools, but they absolutely should be, especially as we age. Our bodies change over time, and with those changes can come new aches, joint pain, or just a general need for a little more support. Pillows help create comfort, reduce strain on hips, knees, and backs, and allow us to stay in certain positions longer without discomfort. Whether it’s propping under the hips for deeper penetration, supporting the knees in a side-lying position, or easing pressure off sensitive joints, a well-placed pillow can make all the difference. For you NS, a lot of the positions you already explore can be enhanced with adding in a pillow.

But back to the positions, the first position that comes to mind would be the spooning, or side-by-side position. I think this position is extremely underrated for everyone, but especially when you’re dealing with arthritis or have a bigger body. There’s no pressure on the hips, no one’s balancing like they’re performing in Cirque du Soleil, and it allows for a lot of intimacy without a lot of strain. I also like it as it allows for slow grinding, deep breathing, and full-body contact. For folks in bigger bodies, this position avoids weight being stacked or concentrated in painful areas, and let’s all partners move at their own pace. Plus, starting with some emotional intimacy (i.e. cuddling) and having it move into sexual intimacy is a great way to check a few boxes.

Another position I wanted to highlight would be modified missionary with a pillow under the knees. Again, the pillow works magic as it lifts the hips just enough to keep things comfortable without putting too much pressure on the joints. This position is especially helpful for people with hip or back pain as well because it gently opens the body without forcing it into deep flexion. For bigger bodied individuals, it provides a sturdy and supported base, letting the focus shift to pleasure rather than positioning. We are not trying to fight gravity or your body. We are working with it, and that changes everything.

While finding the right position is important, I think it is just as important to listen to your body, NS and communicate your desire for exploration. I know you have concerns over initiating and not being able to follow through, but isn’t some connection better than nothing at all? I know the world tells us that the only sex that is considered “sex” is penetrative, but what if we used our 50s as a way to start exploring new options together? That spark is still there, and I want you to be accessing it as long as you want, sex toys, pillows, and lube as your companions along the way. As I wrap up, If you want a book to help dive into these concepts more, check out Magnificent Sex by Peggy Kleinplatz. It is one of my favorite books to give to clients who are looking to rediscover intimacy as they age. If you are like me and enjoy podcasts, check also check out Jane Fleishman’s one called Our Better Half, you won’t be disappointed.

Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.

Disclaimer: The advice provided in this column is intended for general informational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.

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