Recommended Sexual Positions for Elderly with Co-morbidities
For elderly individuals with co-morbidities such as heart failure, stroke, Parkinson's disease, asthma, and COPD, the most appropriate sexual positions are those that minimize energy expenditure, reduce strain on affected body parts, and allow for comfortable breathing and movement. 1
General Principles for All Co-morbidities
- Energy Conservation: Choose positions that require less energy expenditure (3-5 METs or less)
- Comfort: Use positions that minimize strain on affected body parts
- Support: Utilize pillows, cushions, and other supports as needed
- Communication: Maintain open communication about comfort and symptoms
Specific Recommendations by Condition
Heart Failure and Cardiovascular Disease
- Bottom Position: The person with heart disease should preferably be on the bottom during intercourse, as this requires less energy expenditure 1
- Side-lying Position: Both partners lying on their sides facing each other or in spoon position
- Chair Position: The person with heart disease sitting in a sturdy chair with partner on top
- Warning Signs: Stop activity if experiencing chest pain, shortness of breath, rapid/irregular heartbeat, dizziness, or unusual fatigue 1
After Stroke
- Side-lying Position: Particularly beneficial for those with hemiparesis
- Supported Positions: Use pillows to support affected limbs
- Chair Position: Stroke survivor seated with partner on lap or facing them
- Modified Missionary: With the stroke survivor on bottom with pillows supporting affected side 1
- Non-verbal Communication: For those with aphasia, focus on gestures and touching during intimacy 1
Parkinson's Disease
- Side-lying Position: Reduces need for balance and coordination
- Seated Positions: Provide stability and reduce tremor impact
- Timing Considerations: Schedule sexual activity when medication effect is optimal
- Support Devices: Use pillows or wedges to maintain comfortable positions
Respiratory Conditions (Asthma and COPD)
- Semi-reclined Position: Person with respiratory condition partially upright to facilitate breathing
- Side-lying Position: Allows for easier breathing than positions where chest is compressed
- Seated Positions: Partner on lap facing forward or backward
- Oxygen Use: Continue supplemental oxygen during sexual activity if prescribed 1
Important Considerations
Energy Expenditure
- Sexual activity typically requires 3-5 METs of energy, equivalent to walking at 3-4 mph 1
- If unable to walk for 6 minutes without significant symptoms, sexual activity may be challenging 1
- Begin with less strenuous activities (hugging, kissing, fondling) as a bridge to intercourse 1
Environment
- Familiar setting is recommended to reduce cardiovascular risk 1
- Comfortable room temperature to prevent additional strain on respiratory system
- Accessible support items (medications, inhalers, oxygen) nearby
Timing
- Avoid sexual activity after meals, alcohol consumption, or in extreme temperatures
- For respiratory conditions, morning may be difficult due to mucus accumulation
- For heart conditions, allow 1-3 hours after meals before engaging in sexual activity
Warning Signs to Stop Activity
- Chest pain or pressure
- Significant shortness of breath
- Dizziness or lightheadedness
- Rapid or irregular heartbeat
- Excessive fatigue during or after activity
Practical Tips
- Use pillows strategically for support and positioning
- Consider non-penetrative sexual activities when intercourse is too strenuous
- Maintain open communication about comfort and symptoms
- For those with mobility issues, prepare the environment beforehand
- Keep medications (like nitroglycerin for heart patients) readily available 1
Healthcare providers should proactively discuss sexual health with elderly patients, as many continue to enjoy sexual activity into older age despite common stereotypes 2. Regular assessment of sexual concerns should be part of routine healthcare visits for elderly patients with chronic conditions.