Q: I’m worried that my hip replacement will not bear my husband’s weight during sex, even though he is slight. Is the end of our sex life?
Your letter isn’t the one I would select to boost the morale of orthopaedic surgeons. They are, by nature, jolly optimists and, so far as hip replacements are concerned, their confidence is justified. But, as in any operation, there is a small failure rate.
Your surgeons will expect their efforts to be rewarded by you having a more flexible and painless joint. This should cope with all the standard demands that you are likely to make on it, including sexual intercourse.
Younger people have hip joint replacements that have to withstand strains and loads much greater than those induced by having to bear the weight of a slim husband. The impact on the hip joint of your bedroom exercise will be small compared to that experienced by people who are intending to play golf, tennis and even cricket.
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The loss of pain and tenderness that accompanies a successful hip replacement should so restore your general cheerfulness and joie de vivre that after the wounds have healed you will approach with increased enthusiasm many of the activities that may have been becoming a chore when your hip had been deteriorating.
Major surgery sometimes leaves a patient physically mutilated, or with gross scarring, but the scars of a hip replacement, even if large, are not disfiguring. Both men and women can sometimes be turned off sex if they are embarrassed about their post-operative appearance, but this shouldn’t apply to hip replacements.
Research indicates that arthritis in either partner — and your arthritis must have been severe if you are now having surgery — was even more likely to be the trigger that ended an active sex life than either of the two other common causes: loss of libido in either partner or erectile dysfunction in the male.
Immediately after surgery common sense will dictate that this is no time to explore the Kama Sutra. Once the wound has healed and your doctor has given you the all-clear to lead a normal physical life, this should also be the signal that you are able to resume your sex life. It should be as good as it was before your hip began to crumble and certainly much better than in the months that you have been waiting to go under the knife.
Initially, after you recover from the surgery, you may well prefer to give greater emphasis to foreplay. Many disabled people, and you won’t be disabled, are still able to have a satisfying sex life either as the result of oral sex or mutual masturbation without attempting penetrative intercourse. Once you resume full sexual relations you should initially experiment with positions that won’t too much weight on your hips. The standard advice is that the various side-to-side positions, or those with the woman on top, put least pressure on her hips and are the ones that are most likely to initially be both successful and painless. If you are post-menopausal, the resumption of penetrative sex may be uncomfortable for a time. If liberal use of KY Jelly is inadequate, consult your doctor, who can prescribe hormone replacement therapy.
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Recurrent dislocation of the new hip joint may occasionally complicate a hip replacement. Fortunately, this is a comparatively unusual problem, but in the unlikely event of it happening, your surgeon would give you appropriate advice. It is not a reason to avoid sex.
On the contrary. Before the operation your sex life was probably compromised by joint stiffness and pain, so the increased mobility once you recover fully heralds the possibility of a much improved sex life. However, it won’t happen overnight. It takes 8 to 12 weeks for new tissue to grow around the hip joint and for the muscles in the whole area to regain their former strength, so, doctors advise that people who undergo total hip replacement and suffer no post-operative complications should wait about eight weeks before they get up to anything too strenuous in the bedroom.
Eight weeks? The average age of a hip replacement patient is 68, a time of life when any perfectly healthy female libido may need some coaxing. Throw in major surgery and it seems perfectly reasonable that a woman who is just shy of 70 may need a lengthier prescription of daytime telly and nice cups of tea before she feels ready to get up to anything too sexually athletic.
The older you get the longer it takes for any injury to heal, but recuperation is not just a physical concern. Surgery takes its toll mentally, too. Many people feel vulnerable for far longer than they anticipated and right now your most important consideration should not be whether you will, or will not, be able to support your husband’s weight but whether you are, or are not, feeling confident enough to enjoy sex just yet.
If you have any anxieties about your capacity to engage in, and enjoy, penetrative sex, then talk to your husband. He will be just as anxious not to do anything that might put undue pressure on you and your new hip. And since there are so many other ways to be intimate with each other, from kissing and cuddling to oral sex, you may want to stick to some of these until you are ready to try the vigours of penetration. When you feel ready to get back in the saddle, doctors advise that you steer clear of positions that cause too much rotation or flex your hip more than 90 degrees, so swinging from the chandeliers or doing it on the back seat of the car are out.
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Use pillows and cushions to support you and start with low-impact positions such as “spoons” (you lie on the side that was operated on and he lies behind you and enters from behind), or standing positions, where you support yourself by gripping a door frame or a sturdy piece of furniture and he penetrates from behind.
Although you are worried about supporting your husband’s weight, the trusty missionary is one of the safest positions to start with (he supports his body weight with his hands while you lie with your hips moderately bent and your knees apart) as it keeps your hips at the right angle, thereby minimising the pressure on your new joint. You might also want to try lying at a 90-degree angle to him with your legs resting over his hips. As long as you are sensible you can try pretty much anything that feels comfortable, but if a position feels strained, revert to something less strenuous. Full recovery from the surgery takes about three to six months, depending on the type of surgery, your overall health and the success of rehabilitation.
That’s the bad news. The good news is that gentle exercise reduces joint pain and stiffness and increases flexibility, muscle strength and cardiovascular fitness, so a bit of horizontal jogging is, as they say, just what the doctor ordered.
OVER TO YOU
Do you have a sexual dilemma for Suzi Godson and Dr Thomas Stuttaford? Send your e-mails to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT. The authors regret that, although your letters are much appreciated, they cannot respond personally.