My wife and I have enjoyed an active, healthy sex life for most of the 25 years we’ve been married. Recently, though, her knees and my being out of shape have made intimacy difficult. Occasionally we are able to satisfy each other orally, and we still have sex once or twice a month, but we’re both losing interest in it as it’s not as satisfying as it used to be. Do you know any sexual positions that are easy on a woman’s knees? My big belly makes missionary difficult. And do you have any suggestions on how to make it fun again? We both want an enjoyable sex life, but oral sex and toys only go so far. Whether you have knee problems or not, it’s best to avoid putting stress on your knees during sex. Prolonged kneeling, remaining in one position for too long or being unable to stretch your legs can make sex a miserable experience. But there are options. If the regular missionary position is out, you could try a modified version wherein you accommodate your belly by leaning back. Doing this on a padded bench should allow you to straddle it, and with a bit of practice it could work for you. Another good bench position is the “cowgirl” (her straddling you) or even the “reverse cowgirl” – the bench would allow her legs to stretch more, releasing her knees from pressure. You could also try the cowgirl while you are sitting on a chair. Standing at the edge of the bed while she is on her back facing you may also be a good option. Lying in a spooning position but, again, arching your back to create more space for your belly could be comfortable for you both. Preparing for sex by using pain-relieving creams or patches on the knees – and both of you increasing your fitness level if there aren’t health concerns that make this impossible – will be most beneficial. It sounds as though you are both interested in experimenting to improve your erotic play, which is a very positive sign, so have fun trying. Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders. If you would like advice from Pamela on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com (please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions.