Bones, joints, and muscles

Sex and back pain

By Jerry Corners, MD
www.losethebackpain.com

If you or your partner is among the 35 million people who have back pain, you know that back pain can disrupt your sexual relationship. Sex is an important part of the intimacy between couples, and attitudes about sex, rejection, and our self-image when we just don't feel up to a sexual encounter can haunt us for a long time.

Sex is supposed to be pleasurable for both of you and the fear of hurting yourself or your partner inhibits the spontaneous joy that you probably felt before your back pain developed. But what can you do about it? Most couples in which one or the other partner is restricted by back pain will eventually get around to realizing that back pain does not automatically mean no more sex. What it does mean is that you will need to make some accommodations to the pain and/or the fear of it. It also means you will need to talk about sex in a slightly different way.

Let's back up for a second and begin with a very strong suggestion. Because pain has both a psychological component and a physical component, getting a sound diagnosis is critical to putting your mind at rest about what is wrong. Secondly, having a sound diagnosis will also give you guidelines for your physical limitations.

After you have the diagnosis, involve the doctor or physical therapist in a frank discussion about dos and don'ts about sex. Maybe that's an uncomfortable subject for you, but these days, we are talking more openly about sex, and you should tap into the doctor's experience in this area. In a perfect world, the doctor would open the discussion for you, but if he or she doesn't, you may have to initiate it. Ideally, your partner should be present because he or she will have his or her own questions and concerns.

Remember, the health of your back is dependent on many dynamic factors. Your symptoms may change over time so you may need to work with your health care provider from time to time as you go through the many stages of recovery. A word of caution: it is pretty common to begin feeling better, overdo it, and have your back pain symptoms flare up again. We call this "the whoopie effect" and it can happen to anyone. Just remember that as you improve gradually, your activity level should also increase gradually.

As I mentioned earlier, pain has two parts. There is the physical part. This is the actual stimulation of the nerve—like a painful tooth or a herniated disc pressing on the nerve. Then there is the subjective—or the psychological—part. This is how it feels to you and includes, among other things, such attitudes as fear that the pain will get worse or last forever, fear about what it would mean to be chronically disabled, and fear about what you believe your partner thinks about your pain and about how you are coping with your condition.

At the top of your agenda, there needs to be a frank discussion of your pain limitations and expectations about sex. It is a mistake to believe that your partner understands what it feels like. It is your responsibility to communicate those limitations as clearly as possible; it is your partner's responsibility to listen and try to understand.

After all, pain is invisible and subjective. That means your pain is unique to you. We have heard people liken back pain to everything from a hot poker going down one or both legs to a chronic aching sensation localized to the lumbar area. It doesn't matter what words you use, just try to explain the pain, what causes it (position, certain movements, or whatever), and what feels good or what is comfortable for you.

Is it obvious that if it hurts, "don't do it" is generally good advice but some positions and techniques hurt more than others. It may require some gentle experimentation to find out what works but as in most sex advice, "gentle" is the best place to start.

Starting off right

You might want to begin your lovemaking with a massage or by placing ice on the painful area. A warm shower together might help too. That way, the muscles are relaxed.

Positions

Here are some sexual positions that can help you enjoy a pain-free experience.

For males

1. Lie on a firm surface and use pillows to support your knees and head. You might like to try placing a small rolled towel under your lower back.
2. Try a side-by-side position.
3. Place a pillow under your lower back while your partner straddles you on top. You can also sit in a sturdy chair instead of lying down.

For females

1. Try missionary position with the legs bent toward the chest.
2. Sit on the edge of a chair and have your partner kneel between your legs for entry.
3. Rear entry ("doggie style") may also be more comfortable for women with back pain. Try it kneeling on the bed or lying on your belly with a pillow under your chest.
4. Sit on your partner's lap facing away from him as he sits in a chair.

In terms of maximizing sexual pleasure, it is very important to stress that all you really need is your imagination and the willingness to experiment and be open to new areas of intimacy. But it all begins with willingness to try. Given that, you just may find that the lemon of back pain can be turned into the lemonade of new sources of mutual pleasure.