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Health & Exercise Forum

Sex and Back Pain

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Feb 14, 2011

Dr. Mackarey's Health & Exercise ForumThis Valentine’s Day do not allow back pain to limit your sexuality! Back pain sufferers can have fulfilling sex lives! While this topic may be slightly awkward for some, those suffering from back pain realize its importance. Communication with your partner, diagnosis from a licensed medical professional, and limiting pain with proper positioning or use of alternatives to intercourse are three critical areas to consider when back pain interferes with intimacy.

Clear and honest communication with your partner is at the top of the agenda. Back pain is invisible, subjective, and unique to the individual. Therefore, it is your responsibility to help your partner understand your limitations. This is accomplished with a thorough discussion of positions and movements that elicit pain in order to discover the most comfortable alternative. Also, it is your partner’s responsibility to listen and try to understand. Moreover, both partners need patience, tolerance, imagination, and gentle experimentation to maximize sexual pleasure.

Schedule a visit with your physician to accurately diagnose the origin of your back pain. Your doctor may recommend referral to a physical therapist for examination and testing in order to determine your physical limitations. Guidelines for specific positions and movements which support your back and minimize pain will be provided. Remember you may have to initiate this discussion with your physician or a physical therapist. Ideally, your partner should be present to express his or her questions and concerns.

Remember, sex does not necessarily mean intercourse! Alternative sexual techniques (massage, digital stimulation, or oral sex) may be initially required when extreme back pain prohibits penetration. Take time to pleasure each other. Giving stimulation can be just as erotic as receiving it!

To discover the sexual positions that provide the most comfort requires some imagination, creativity, and experimentation even after your medical professional has educated you about supporting your back to minimize pain. Some individuals with back pain achieve pain relief with bending forward (flexion) and others with bending backwards (extension). Sexual positions need to be adapted for each and every individual. 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. Here are some suggestions:

  • Listen to your body! Follow the golden rule: “If it hurts, don’t do it.”
  • Pregame Preparations! Heating (massage, heating pad, hot showers) or icing the painful area before sex may improve success.
  • Lying on your back maybe on of the best positions. If you can bear your partner’s weight, lying one your back provides a stable position for having sex. Because your back is supported by the bed or floor, less physical strain is placed on your muscles. Try a small pillow or towel roll to support your lower back and/or neck.
  • Lying on your stomach while propped up on your elbows is the second most comfortable position. Stomach positions offer comfort if you need feel better with your back slightly extended backwards.
  • Side lying: Side lying is worth trying if back or stomach lying is painful. It is safe for almost everyone, since neither partner bears any weight. Side lying is typically a neutral position, but the partner in pain can flex or extend slightly by changing the position of the knees and pelvis.
  • Try to avoid twisting the spine.
  • Kneeling: This is a more advanced position that does not support the back. Kneeling allows the woman to extend and easily adjust her position for greater comfort.
  • On hands and knees: If the woman needs to extend and does not have a neck problem, having sex on hands and knees may be comfortable.
  • Sitting: If flexion is required, sitting positions may feel most comfortable. To maintain the best support, the man sits with his back against the chair. A straight chair without arms is the best choice.

Valentine’s Day should be a romantic time for lovers. Sex is an important part of an intimate relationship. Do not allow back pain to condemn you to life without sex. Appropriate education, an open attitude, and effective communication can help you recover what you lost and may even result in something better than what you had before!

CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.