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I am in my 60’s; my husband 82. I had a hysterectomy 3 years ago with mesh. He had a mild stroke and is in physical therapy. He also has bad knees and needs replacement. He wants to have sex as we did 25 years ago, missionary. Now he can’t put pressure on his knees, so I suggested we start on our side and see what happens. Any thoughts or other safe ways. He needs to have sex with me. Thank you.

Dr. Melanie Davis and Dr. Judith Hersh say: Your husband has expressed a very common desire, which is to have the kind of sex that was enjoyable and predictable for many years. The reality, however, is that even if he has his knees replaced, he will experience common, age-related changes in his ability to attain or maintain an erection, i.e., he may also take longer to get aroused and need more direct penile stimulation. His ejaculatory force will be less than 25 years ago, and he may have less sexual endurance. It’s important for him to understand that these are normal changes that needn’t decrease his sexual satisfaction, as long as he isn’t comparing his sexual self today with himself 25 years ago.
You’re right to suggest side-by-side sex positions to take the pressure off his knees. Other positions to consider: You could stand next to your bed, bending forward so that you are supported by the bed or with your arms — a few extra pillows may add comfort. Your husband can then stand behind you, entering you from behind. Another option is for him to lie down while you position yourself on top and support yourself with your arms while you raise and lower your hips.
Sex may not be the same as it was in your old missionary-position days, but new positions will let you enjoy new sensations and ways of pleasuring each other.
You may also want to experiment with oral sex, if that’s not already part of your sexual bag of tricks. Also, there are also an increasing number of adult sex toys designed for both men and women pleasure.
Regarding your own sexual health: The mesh that was inserted after your hysterectomy shouldn’t interfere with sexual activity or pleasure, if your tissues are healthy. If you feel pain or experience tearing during sexual activity, you may need to apply topical, vaginal estrogen cream to keep your tissues pliable and less prone to injury. Your healthcare provider can assess whether this is a good option for you.

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