Back pain, whether it is acute or chronic, can interfere with our lives in a big way. Back pain can impair our ability to function: to drive, to get dressed, to bathe, to transfer from sitting to standing and back again. Back pain also can negatively impact our ability to get restorative sleep.
But many of us don’t like to talk about the negative effect of back pain on our sex lives. Anything that impairs our sex life is significant and deserves our attention. Intimacy and sexuality are important components of overall health and psychological well-being. Anything that interferes with the positive aspects of sexuality needs to be addressed.
Communicate with your sexual partner about your physical pain. Be as direct but as sensitive as possible. State what aspects of sexual functioning hurt or are challenging and what you hope your sex life can be. Some things to discuss: How vigorous a sex life do you desire? How much are your needs met with cuddling? How can you overcome these obstacles? Can non-penetrative sex substitute for a time? How does your partner feel about your back pain?
Communicate with your health care team. Do not be afraid to discuss sexual functioning with your doctor (and bring your partner along for these discussions). In addition, be frank and ask questions of your physical therapist as well as other members of your wellness team. Elicit specific advice about sexual positions to reduce pain and don’t be shy; your health care team is well aware that many of the patients are sexually active!
Prepare for sexual encounters. When pain enters the bedroom, there are some steps you can take to try to ensure a positive encounter. If your doctor recommends it, consider taking over the counter pain relief prior to sex. Do what you need to do to be relaxed, taking a warm shower or bath, gently massaging each other, even changing the lighting and the music. Prepare both your body and your brain.
Understand the physiology of sex and consider “changing positions”. Be aware if your back pain worsens if you are standing straight, bending forward or bending backward.
When bending forward hurts:
Men who don’t like bending forward would do best trying the missionary position, especially if the man supports himself on his hands. Men may also prefer lying on their own backs or sitting up.
For women who don’t like bending forward, placing a pillow or rolled up towel underneath their lower back while lying face-up can help. Women need to be very slow and careful in the manner that they bend their legs while lying on their backs, as it could cause extra strain on the back. A better position might be with the woman on top or even lying face down.
When Bending Forward (Flexion) Feels Better:
A man with lower back pain who prefers flexion might be more comfortable with any rear entry sexual positions, either with both partners on all fours on the bed, or with the man standing behind his kneeling or standing partner, or even both partners lying on their sides.
Women who experience less pain when bending forward may find the easiest position is the missionary position, especially if the woman can bring her knees up as close to her underarms possible. Women may also prefer sitting upright and bending forward slightly.
Let the partner without pain do the heavy lifting: The more passive the partner who experiences back pain can be during intercourse, the less likely they will have a back-pain flare-up.