Knee problems, specifically issues with the ACL (anterior cruciate ligament), are incredibly common for people of all ages.
Knee issues and ACL issues arise with overuse, landing wrong from a jump, turning too quickly or in the wrong way, direct blows to the knees, and too much pressure on the joint (such as with heavy weightlifting).
Over 100,000 people a year undergo ACL surgery in the United States.
Knee problems and injuries can impact your sex life. Living with chronic pain is tiring and drains your desires to engage in many physical activities.
If you are used to engaging in sex using positions which put stress on your knees, this can become undesirable, and you avoid the activity.
Additionally, the stress hormones released with chronic pain can dampen a sex drive. Luckily ACL and other common knee injury treatments have high success rates and people get back to their regular routines shortly after surgery.
The good news is, after ACL and hip surgery, patients generally report a greater satisfaction with their sex life. According to a study about sex pre- and post- surgery:
- 42% of patients reported improvement in their libido
- 36% reported having sex more often
- 41% reported having longer sex sessions
- 55% reported improvement in sexual function
- 90% reported greater enjoyment with their sex lives
Understanding ACL injuries and surgery
The knee is composed of four bones (femur, patella, tibia, fibula), four ligaments (stabilizing soft tissue), and the meniscus (cartilage disk which provides padding between the bones).
A knee injury may involve fracturing any of the bones, tearing or rupturing a ligament, or tearing or disintegration of the cartilage.
All these injuries may present as pain, swelling, aching, limited range of motion, or a feverish knee.
The ACL (anterior ligament which helps stabilize the knee) is commonly injured by people who play sports. The ACL can tear or rupture, destabilizing the knee and causing pain.
You will need a medical diagnosis to determine if there is a need for surgery or if your knee can be helped with rehabilitation, icing, and over-the-counter medications.
Surgery to repair the ACL and many other types of knee surgery involve using a small camera inserted through an incision and tools inserted through other incisions. Most surgeries are performed on an out-patient basis, meaning you will go home the same day you have surgery.
After you have surgery, the knee will generally be stabilized with a brace, and you will need to use crutches for about two weeks.
After that, you will be given a knee brace and encouraged to start putting weight on your leg.
The use of a brace generally lasts four to six weeks. Rehabilitation therapy is common during this period, helping you regain a range of motion and strength in the joint.
Most people fully recover from ACL surgery within nine to twelve months, meaning you can go back to all or most regular activities without restrictions.
Your doctor will let you know when you can fully return to your activities.
Sex pre- and post- knee surgery
After you injure a knee but before you undergo surgery you will experience pain in the joint. This may put a damper on sexual activities.
However, some people still enjoy having sex even with knee pain.
If you want to have sex during this period, follow these tips to help reduce pain and reduce the chance of increasing the damage to the joint.
Ice and anti-inflammatory medications
Icing a damaged knee is generally prescribed. Place an ice pack or a frozen bag of peas on your knee and ice it for about 15 minutes. Avoid over-icing by limiting your icing periods to no more than six times a day.
Acetaminophen and ibuprofen are over-the-counter anti-inflammatory medications which can help with pain and swelling.
If you take other NSAIDs (e.g., Meloxicam) ask your doctor which over the counter medications you can take safely. Do not exceed the dose on the bottle to avoid stomach irritation or other side effects.
If you take an anti-inflammatory medication and then ice for 15 minutes, your knee will be at its least painful point when you start to have sex.
If you still feel a lot of strain, you can get a knee brace at a local pharmacy which will help take some of the pressure off the joint.
Sex post-surgery
You will want to check with your doctor as to when you can safely return to sexual activity.
For most people the first two weeks post-surgery will require significant accommodation to make sex safe and enjoyable.
In weeks three to eight, using the suggested safer positions below can increase safety and reduce the chance of reinjuring your knee.
Two months to nine months after surgery, you will want to limit your positions to those which do not put pressure on the knee or twist the knee during sex.
By month 10 post-surgery, you should be back to your full routine.
Communicating with partner(s) about your temporary limitation is critical to keep you from further damaging your knee during sex.
Depending on the type of relationship you have with your partner, you may want to let them in on all the details or you may just want to let them know that due to a temporary injury, you can’t enjoy certain positions.
Best sex positions for people pre- and post- knee surgery
When you have experienced a knee injury, you will want to choose sex positions which take pressure off the knee.
Avoid positions which require kneeling (e.g., doggy style) require pressure on the joint (e.g., cowgirl if you are on top) or twisting the knee (e.g., pretzel dip).
Use pillows to help support your leg and knee in some of the following positions.
Missionary
Missionary is safe for you in both positions (on top or bottom). If you are the partner on the bottom, keep your legs straight and avoid twisting them open at the hip to reduce stress on your knees.
If you are on top, use your hips as the point for thrusting and resist the urge to kneel slightly for more power. If you are the person on top, a knee brace can be particularly helpful in this position.
Standing against a wall
This position is safe for either partner with a knee injury. For this position, the person being penetrated stands facing the wall and uses their arms and hands for support. The penetrating partner stands behind them to enter them.
If there is a significant difference in height between the partners, the shorter partner may want to stand on a sturdy box or exercise step. Avoid standing on a step ladder or pile of books as this will make the person unstable and more likely to fall.
Seated in a chair
This position is safe for either partner with a knee replacement. One partner sits in a chair with their feet on the floor. The other partner straddles them, facing their partner.
This position allows for a significant amount of intimacy. Kissing, talking, and touching other body parts is easy in this position.
Don’t forget the support pillows!
Using pillows and other supports after surgery can make sex feel much more comfortable. Use pillows to support the injured leg by propping it up when you are on your back or side.
You may want to invest in a specialty pillow for sex support. Sex pillows, like Pillo by Dame are much firmer and designed to better support a body part during sex.
Non-penetrative activities
Many people think about sex as just sex involving a penis penetrating something! There is so much more to explore.
Having ACL surgery or a knee injury can be a great reason to try out other activities you may not have explored or haven’t done in a long time.
Oral sex
Oral sex offers a lot of position options and fun for people recovering from ACL injuries. Try some of these safe positions for your oral pleasure!
Receiver standing - giver seated
This is a very safe and comfortable position if both of you have knee problems. The giver sits on the edge of a bed or comfortable chair.
The receiver stands in front of them. The giver can support the receiver by placing their hands on their partner’s lower back or bottom during oral sex.
Lazy Sunday
For this position, the receiving partner lies on their back with their legs open a bit. The giver lies on their stomach between their partner’s legs.
Either partner may want to use pillows to help support themselves to make this more comfortable.
This position is easily maintained by both partners for an extended period.
If the person with the injured knee is on the bottom for this position, use a pillow under their legs to help support them and keep them comfortable.
If the person with the injured knee is the giver, make sure there is enough surface to support their full leg.
The giver may also want to place a pillow under their lower thigh (right above the knee) to take any pressure off the knee. In this position, the giver will want to avoid bending their knees.
Invest in a few good sex toys
Sex toys are happy little helpers in bed and not your competitor. Investing in the right sex toys can make sex more comfortable, help both of you climax more regularly, and increase the amount of time you enjoy sex in one session.
Wand vibrator
Wand vibrators are great toys! These versatile toys can be used by people of all genders on many body parts. Additionally, they make great massage tools for any achy body part.
Wand vibrators come in many sizes from small travel-sized to upward of 15 inches long. You want to choose a wand which will be comfortable for you to hold for up to 10 minutes at a time.
Your personal hand size and strength will help determine which wand you will want to buy. For a guide on selecting the right wand for you, check out this post on Love Letters To A Unicorn.
Wand vibrators are great for using on a clitoris. They provide various levels and patterns of vibrations which help many people reach climax. The head of the wand also feels good when used underneath the testicles and on the shaft of a penis.
Most people with penises find they prefer a very light vibration in these areas, so start of the lowest setting when trying a wand in these areas.
Some people enjoy using the wand on the area between the genitals and anus. Wands with a deeper vibration or strong vibration pattern can be used here to stimulate the G-spot or prostate from outside the body.
If you do use the vibrator in this area, make sure you clean it with warm, soapy water before using it on a clitoris to prevent a urinary tract infection.
If your partner enjoys intense nipple stimulation, using the wand on their nipples directly or on nipple clips attached to their nipples will provide a new and interesting sensation.
Many wand models also have various wand attachments which can be used for a variety of types of stimulation.
If you or your partner have a difficult time providing a hand job for a person with a penis, a masturbation sleeve attachment can be very helpful. Make sure to add lubricant to the sleeve to improve the sensation and prevent the sleeve from tugging on skin while being used.
Remote-controlled and app-Based toys
There is an enormous selection of remote-controlled vibrators and app-compatible vibrators toys for all genders. These toys can be controlled with a small, handheld remote or through an app on a cell phone. Wearable vibrators can be worn without any pain on the knees whatsoever.
Toys for penises
Vibrating cock rings & butt plugs
Cock rings fit over the shaft of the penis and rest at its base. They can help people keep erections by assisting to keep the blood in an erection longer than it would stay without one.
Additionally, vibrating cock rings can help increase stimulation and assist with orgasm.
Models like the We-Vibe's Bond can be controlled by a phone app. This allows someone to control their own toy with their phone, a partner can control the toy during play, and people can log in remotely and stimulate a partner from anywhere in the world.
This is especially useful for people who are in long-distance relationships or may not currently be with a partner.
Some cock rings come with an additional butt plug. These toys fit around the shaft of the penis at the base and then the plug is inserted into the anus.
Remote controlled options like the B-Vibe Snug and Tug provide the benefits of a cock ring with the additional benefit of prostate stimulation.
Because people with arthritis often have co-occurring conditions like heart disease or diabetes which can impact sexual function, a cock ring and prostate stimulator can be very helpful in assisting in getting an erection and reaching climax without adding other medications.
Toys for vaginas
For people with vaginas, stimulating the clitoris or G-spot is often necessary in order to reach orgasm. If you have difficulty stimulating your own clitoris or a partner’s remote controlled and app-based toys are a great option.
There are many remote and app-controlled toys designed to assist in stimulating the G-spot. G-spot vibrators like the We-Vibe Rave or Rave 2 are app-controlled toys.
The vibrator is inserted into the vagina and positioned to touch the G-spot. The app is then used to control the intensity and pattern of the vibrations. Like many app-controlled items, this toy can be controlled by the wearer, a partner, or someone in a distant location.
Other couples vibrators offer a wearable option. These toys fit in the vagina and wrap around to reach the clitoris. These toys can be worn while doing other things, like having a romantic dinner.
The We-Vibe Chorus is a great example of this type of wearable toy. The app allows separate control over the G-spot and clitoral vibrations. This allows you to customize the type of stimulation you enjoy the most.
Sexy pedicure
After knee surgery, reaching your toes will take time and can be painful in the beginning. One way to help get into a sexy mood post-surgery is to have a partner give you a pedicure.
If you are the partner giving the pedicure, wet two hand towels and ring them out so they are not dripping.
Microwave the towels for one minute on high. Alternatively, you can run the tap until very hot water comes out. Wrap the hot towels around your partner’s feet to warm and soften the skin.
While the towels warm your partner’s feet, this is a great time to kiss them and start talking about happy, relaxing things to help ease them into feeling sexy. Unwrap one foot. Trim and file the nails. Then, using a good massage lotion to massage their foot. Repeat on the other side.
You may find using a wand massager can help get into the arch of the foot and the ball of the foot better than your fingers can. Use a non-corded version.
A pedicure will leave your partner feeling relaxed and very cared for. This type of pampering can also be very intimate. If you are comfortable with it, try giving the pedicure wearing something sexy or nothing at all.
When you have finished massaging their feet, begin kissing their legs and work upward.
If your partner has been sitting on a chair or the couch during the pedicure, this puts you in prime position to start giving them oral sex. Or straddle them for the seated chair position (described above).
Post-surgery and not in the mood
Surgery can take a lot out of a person. It causes tiredness and fatigue and can leave someone feeling not sexy. This does not mean your partner will feel the same.
If you are post-surgery and not in the mood but your partner is, find a way to compromise so that both your needs can be met.
Exhibitionism
If your partner wants to have sex but you are just not feeling up to it, have them demonstrate stuff for you. Ask them to give you a sexy strip tease or masturbate in front of you.
You can add a remote-controlled toy to their masturbation session to bring yourself more into the mix.
Invest in a remote-controlled or app-controlled toy you can both enjoy. The We-Vibe Vector is a butt toy which works for all genders.
Have your partner wear this toy and dance, strip, or masturbate for you while you pleasure them with a click of your phone!
Sexy audiobooks and stories
If you are not in the mood, try listening to an erotic story together.
There are millions of erotic audio books available on various apps as well as entire websites dedicated to erotic storytelling. Your partner may want to masturbate while both of you enjoy a bedtime story!
For people with penises, investing in a good male stroker (manual stroker or one of the hands-free masturbators) or fleshlight toy can add an extra layer of pleasure to masturbation.
Penis sex toys have much more of a stigma around them than toys for the vagina and clit. Encouraging a partner to explore one of the male masturbators and strokers gives them more options for solo sex and sex with you!
Consider getting a penile sleeve attachment for your wand vibrator. Make sure to get a good water-based sex lubricant to go along with the attachment!
Final thoughts
Knee injuries and knee surgery are not the end of your sex life by a long shot! There are many ways to enjoy sex pre- and post- surgery. Most people will be back to their full range of activities within a year.
About the author
Rebecca Blanton, aka Auntie Vice, is a writer and kink educator. She holds a Ph.D. (abd) in Political Psychology and a BA in Psychology.
Their work focuses on gender, power, and kink//BDSM. She runs the award-winning blog LoveLettersToAUnicorn.com and has published several books, including The Big Workbook for Submissives, a finalist for the 2018 Golden Flogger Award. She has taught about kink and submission for the past seven years.
She regularly performs stand-up and storytelling. Prior to turning her attention to kink education and writing, she served as the Executive Director for the California Commission on the Status of Women and Girls and worked as a Senior Policy Analyst for the California Research Bureau.