Sexual Position Modifications for Pain-Free Intimacy: A Scoping Review.

BACKGROUND: Sexual pain disorders impair intimacy and quality of life. While clinicians routinely recommend sexual position modifications, evidence is scattered in gynecology, urology, physiotherapy, sex therapy, and biomechanics. OBJECTIVE: To systematically scope and synthesize evidence on sexual position modification alone or as part of multimodal care to decrease pain and enhance sexual function in adults with sexual pain disorders. METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searched Medical Literature Analysis and Retrieval System ON-LINE (MEDLINE), Embase, Scopus, Web of Science, Cochrane, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Institute of Electrical and Electronics Engineers (IEEE Xplore), and grey literature from January 2000 to August 2025. Two reviewers independently screened, extracted, and appraised studies (κ = 0.84) using a revised tool to assess risk of bias in randomized trials (RoB-2), risk of bias in non-randomized intervention (ROBINS-I), the Joanna Briggs Institute (JBI) Scale, and the Critical Appraisal Skill Enhancement tool (CASP). Included designs were randomized and quasi-experimental trials, observational studies, qualitative studies, and biomechanical/magnetic resonance imaging (MRI) studies to provide a comprehensive overview of the study. RESULTS: From 2,146 records, 27 studies were included (3 RCTs, 1 secondary randomized control trial, ∼10 observational, 7 qualitative, 5 biomechanical/Manetic resonace imaging (MRI). Partner-controlled depth, angle, and tempo consistently reduced pain and improved sexual function. In Physical Vapor Deposition (PVD), cone beam computed tomography (CBCT) and multimodal pelvic physiotherapy outperformed lidocaine. Post-surgical endometriosis improved with sensate focus and guided position change. Woman-on-top, side-lying, and supported missionary were favored; rear-entry often worsened dyspareunia. Biomechanical/Magnetic Resonance Imaging (MRI) data supported plausibility of position-dependent changes in anatomical contact and tissue strain. CONCLUSIONS: Position adjustments emphasizing depth control and partner synchronization appear feasible, safe, and beneficial, with the strongest evidence in vestibulodynia and moderate evidence in endometriosis.