Whether you place the pillow sideways or upright depends on what you’re trying to achieve. Here are the most common goals and the recommended positions:

1. Support under the hips (missionary or similar)

Place the pillow flat under the receiving partner’s hips so the pelvis is tilted upward. This often improves comfort and angle. The pillow should lie horizontally across the bed with the long edge running side-to-side, not upright like a wedge.

2. Support under the knees or lower back

If you need knee or lumbar support, the pillow can be folded or rolled lengthwise and placed under the knees or lower back. In this case the pillow is still horizontal, but you may tuck or fold it to create a firmer roll.

3. Using a wedge or firm pillow

Specialty sex wedges are designed to be placed with the tall end toward the head or feet. If you are using a regular pillow as a substitute, keep it flat rather than standing it on edge; standing a pillow upright usually collapses and provides little support.

General tips

• Choose a firm pillow; soft ones compress too much and lose their supportive shape.
• Make sure the neck and spine remain neutral—avoid extreme arching.
• If either partner has back, hip, or neck issues, consult a healthcare provider or physical therapist for personalized positioning advice.

Experiment safely and communicate with your partner about what feels comfortable. If you experience pain, stop and reassess your setup.