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Back Pain and Sex

by Chelsea Commander, APRN, FNP-C


Back pain will affect 8 out of 10 people at some point in their lifetime.  People who suffer from back pain, especially chronic back pain, will have negative impacts on activities of daily living.  It is no surprise that intimacy can also be seriously impacted as well.

The negative effects that pain can cause in a couple’s relationship can be extensive.  It is critical to have open communications with your partner.  Fear of pain can cause hesitancy in engaging in sex.  This can be mistaken for other causes by a partner leading to feelings of rejection, resentment, or suspicion.  Openly discussing feelings and reason for reluctance can help avoid this.

Planning ahead of intimacy can be a way to diminish back pain and discomfort.  Taking pain relievers, especially anti-inflammatories (NSAIDS), can be beneficial.  Also, for those suffering from spasms and tightness in the back, taking muscle relaxers and/or a hot shower can While these medications may help with pain, it is important to keep in mind that for some people certain medications will result in erectile dysfunction that cause negative impacts instead of yielding benefit.

Depending on the underlying diagnosis for a patient, there are certain modifications that can be made regarding sexual positions that can lead to less pain.  Some patients are intolerant to leaning forward or “flexing forward.”  The common diagnoses that will cause this are herniated disc and degenerative disc disease.  For men suffering from these conditions, the missionary position, where he supports himself on hands and extends backwards, can be the most “spine conserving”.  Another option is for the man to lie on his back with a pillow under his low back.  For women with flexion intolerance, recommendations include lying on her stomach with a pillow under her chest, or the sitting position which allows control over her movements and the position of her back.

Other conditions will cause pain with extension or “arching back” and feel better leaning forward.  The most common of these conditions include spinal stenosis and facet arthritis.  For men with extension intolerance, kneeling down and leaning over forward is best tolerated.  The fetal position for both persons may also be well-tolerated.  For women with these conditions, missionary position with knees bent is fairly easy on the spine.  Kneeling and leaning forward is another alternative.

Open communication between partners is the best starting point for keeping a relationship healthy.  Although it is inevitable that pain will affect a relationship, discussing the reasons as well as modifications and adjustments, will lower stress and resultant depression.  Less stress and depression alone will lead to less pain.  Do not hesitate to discuss the repercussions of back pain with your physician.  Be sure to ask how a specific back condition may affect you, and follow the advice given by your physician.  Back pain can limit one’s physical ability but does not have to limit sexuality.