A stroke diagnosis can change many things in a person’s life: their mobility, their cognition, their relationships. Included in this is the ability to have sex.

For many people, sex is a vital part of life. It’s something that fosters connection and brings pleasure, making it important for many relationships. Not everyone needs it, but for those who want sex to be part of their relationship, it’s important to find ways to work around any post-stroke limitations.

Given the body’s changes after a stroke, it can be difficult to know how to proceed with sex in a way that will be satisfying for all parties. Being a stroke survivor doesn’t mean that sex is no longer an option, it just requires a newfound curiosity to explore and patience with the process. Not everything that used to be pleasurable before the stroke will continue to be enjoyable, so it’s important to experiment and communicate.

Ultimately, what’s most important is communicating openly and honestly with a partner or partners, so that this new period of trial and error is a stress-free experience geared towards mutual pleasure and comfort.

One thing that can help in this process is understanding what positions have worked for other survivors. Here, we’ve curated six sex positions based on input from stroke survivors. These may not work for everyone, but hopefully they can serve as a guide for what to try first. It’s important to note that at Springrose we’re focused on improving quality of life for women. As such, these positions are based on the assumption that the stroke survivor is the woman or person who is on the receiving end of penetration. Also, we suggest always trying to pair up a penetrative pose with a clitoral vibrator or manual stimulation. You can find some suggestions for adaptive sex toys here.

1. Standing Missionary

For this position, the stroke survivor lays on their back on a bed with their butt lined up to the edge. The thrusting partner stands in between their legs and picks up their legs, holding them up throughout penetration. This can be at waist level or even putting them on top of their shoulders, depending on the desired level of penetration and the survivor’s comfort.

This way, the thrusting partner is responsible for the movement, and balance or muscle strength are not required from the partner on the bed. This position is also great for clitoral stimulation, whether manual or with a sex toy. Further, the angle and comfort for the stroke survivor can be changed by adding a pillow or wedge pillow underneath the lower back.

2. Spooning

This sex position is a great option but requires a lot of work from the partner performing the penetration, so it may be better suited for quicker sex. Both parties lay on the bed in a spooning position with the thrusting partner behind the stroke survivor. Given the lack of leverage for the thrusting partner, they may need to bend their leg at an angle that allows them to put the sole of their foot on the bed. If this makes the angle of penetration difficult, pillows should be used to adjust the height. The position has two variations depending on the pain the stroke survivor feels from their affected side. If laying on the affected side does not cause pain, then it’s a great option for having a free hand to touch their partner or for clitoral stimulation. If it does cause pain, then the stroke survivor should lay on their unaffected side and their partner may be able to reach over to add that extra pleasure.

3. Side Thrust

This sex position is one of the more challenging ones, but it’s a variation of the spooning position where the thrusting partner has more leverage. The stroke survivor would be laying on their side while their partner is in between their legs with the topmost leg laying on top of their partner's thigh. The partner can also assist in this position by holding up the leg if desired, so that less muscle strength and effort is required from the survivor. This can be difficult depending on the pain from the affected side, so it’s important to play around with the angles and with which side is most comfortable against the bed. Further, it’s important to use pillows as needed between the stroke survivor and the bed to improve comfort and ease any tension.

4. Reverse Missionary

This sex position is a great option for feeling close to your partner while still having a great time. The thrusting partner lays on their back on the bed while the stroke survivor lays on top of them, facing them. The survivor’s legs are extended and in between their partner’s legs. The partner’s legs, on the other hand, are propped up at an angle so that their soles are against the bed. This will give the partner leverage for thrusting and it allows for more speed control and variability. The survivor can also prop their head up on an elbow on the unaffected side, depending on their muscle strength.

5. Puppy Pose

A classic, puppy pose is a good option for those who have some strength on their affected side, particularly their leg. It’s a sex position that allows for deeper penetration and speed control, and both parties can engage in the thrusting depending on the stroke survivor’s muscle strength. For this pose, the stroke survivor would get on their hands and knees on the bed before releasing the weight on the arms and bending forward. It will result in the body being bent at around a 45 degree angle. The thrusting partner can then kneel behind them or stay standing depending on how close they are to the edge of the bed. This position can sometimes be uncomfortable for the back of the person in puppy pose, so a pillow or wedge under the chest and stomach is recommended for added comfort. And, depending on muscle strength and balance, clitoral stimulation is possible with the able hand or the partner’s help.

6. Over the Edge

For our final sex position, it’s one that somewhat depends on the height of the bed and the strength of the stroke survivor’s affected leg. If the bed is close to the ground, then both partners can do it while kneeling. If the bed is at waist height then both parties can be on their feet. If it’s in between, then this position might not be an option, but a table could be used as an alternative. In this position, the stroke survivor would stand at the edge of the bed and lean over until their upper body is completely against the bed. The partner would then stand behind them for penetration and can change the depth of penetration by changing the angle of their body – leaning forward or backward. A pillow under the chest and stomach might be beneficial for comfort or to provide space between the bed and the person’s head. Further, this is also a great position for adding manual clitoral stimulation or a sex toy.