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sex with a hip impingement

When it Comes to Sex With a Hip Impingement, Position Really Does Matter

It's no surprise that if you recently had hip surgery - or have an ongoing hip issue - that your sex life could suffer. Read on for some recommendations.

What is Femoroacetabular Impingement (FAI) Syndrome?

Femoroacetabular impingement (FAI) syndrome is a disorder of the hip that typically affects young adults. It is the result of an abnormal contact between the greater trochanter of the femur (thigh bone) and the acetabulum (the socket).

FAI is one of the most common reasons why people undergo arthroscopic surgery on their hips, but many people are treated via conservative pathways (PT, rehabilitative exercise, joint injections). The symptoms of FAI syndrome include motion- or position-related hip and/or groin pain. Pain may also be felt in the back, buttock or thigh. In addition to pain, patients may also describe clicking, catching, locking, stiffness, restricted range of motion or giving way. (Griffin et al., 2016).

Hip Issues Affect Your Sex Life

It makes logical sense that having FAI and other ongoing hip issues could put a damper on your sex life. Sex can require a lot of interesting positions and hip motions, which are not always egonomic. Researchers Lee et al. (2015) confirmed this hypothesis when they found that most patients with femoral acetabular impingement syndrome (FAI) reported sex with a hip impingement to be difficult due to their discomfort.

A new study by Morehouse et al. (2020) used state of the art imaging techniques to see the kind of stress 15 different sex positions put on your hip joint. FYI the definition of sex for this study was penetrative sex between a heterosexual couple… However I think we can extrapolate findings for those engaging in non-heteronormative play!

The aim of the study was to identify positions for sex with a hip impingement that could be recommended to patients who had recently undergone hip arthroscopy, or who had ongoing hip impingement issues or were at risk for developing a hip impingement issue.

12 common sexual positions were reviewed via MRI to see the kind of hip motion that is required of both participants, and the study identified positions that are either safer or less safe for those who have had recent hip surgery or ongoing impingement.

You can see these positions in this diagram:

sex with a hip impingement positions

Image from Morehouse, H., Sochacki, K. R., Nho, S. J., & Harris, J. D. (2020). Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. The Journal of Sexual Medicine. doi:10.1016/j.jsxm.2019.12.026

Safe Movement Paramaters

Hips get more unstable with more than 0 degrees of hip extension (think leg going out behind you), greater than 30 degrees of external rotation (think knees pointing “out” or duck feet), or greater than 30 degrees of abduction (think “spread eagle”). Hips face a larger risk of impingement if the hips go past 90 degrees of flexion (knee to chest), more than 10 degrees of internal rotation (going “pigeon toed”), and more than 10 degrees of adduction (legs crossing midline). Perhaps a little confusing for those of you who have not taken anatomy classes, but bear with me!

Using these recommendations listed above, if the “blue character” is the person with hip issues, the safest positions are 3, 5 (when laying on the problem side), 9, and 12.

If the “pink character” is the person with hip issues, positions 1, 2 (laying slightly on left or slightly on right side), and 9 are safest.

You’ll notice that the safe positons for sex with a hip impingement stay in line with the safe movement recommendations listed above: legs don’t tend to go back behind you, knees and legs stay neutral (no turning in or out), and hips don’t go into too much flexion (knee to chest), avoid too much abduction (spread eagle), and also avoid any crossing of the legs past midline.

Recommendations for Those Who Have Had Recent Hip Surgery

Current evidence shows 100% capsular healing at 24 weeks post-op, so if you’ve had hip surgery recently, you should be safe to have sex after 6 months. Keep in mind this is a conservative recommendation, because some wonder-kids are pain free 48 hours after operation. So, if you feel comfortable talking with your doctor about this, ask them for their opinion.

If you are confused by all of the anatomical terms of this blog post and in the journal articles, come see one of our therapists and we can give you some personalized recommendations, based on our in depth evaluations and treatment sessions. Give us a call or make an appointment today!

References

Griffin DR, Dickenson EJ, O’donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016;50:1169-1176.

Morehouse, H., Sochacki, K. R., Nho, S. J., & Harris, J. D. (2020). Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. The Journal of Sexual Medicine. doi:10.1016/j.jsxm.2019.12.026

Lee S, Frank RM, Harris J, et al. Evaluation of Sexual Function Before and After Hip Arthroscopic Surgery for Symptomatic Femoroacetabular Impingement. Am J Sports Med 2015; 43:1850-1856.

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I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

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No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

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I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

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I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

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I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

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