Whether you have a little twinge or serious back pain during sex (and who doesn’t now and then?), these preventive measures can help ease the pain.
Explain the problem. Don’t leave your partner in the dark. Chances are, if you seem unwilling to have sex, your partner may interpret that as rejection. That’s almost as painful as back pain.
It’s hard to admit to physical limitations, especially in the sexual arena, but this is one of those topics that need airing. Then, it’s possible for your partner at least to understand the issue and more likely to become an ally in the search for solutions.
Medicate. Take an ibuprofen-type medication before sex. Or discuss using another pain-killer with your doctor.
Prepare. If your muscles tend to spasm, a hot shower before sex and cold compresses after could help. Or work a little massage with painkilling cream into your foreplay.
Innovate, don’t stress. Take your time. At this stage of the game, sex is more about connection than athletics. It’s more about enjoying the moment than setting off fireworks. Depending on the type of pain, try positions that support your back and reduce spinal movement. Experiment with support pillows to see what keeps you both comfortable. Or switch to other types of pleasuring if things get too gnarly.
Ergo, if you suffer from back pain—and a whole lot of people do—you’re probably having sex less and enjoying it less, as well.
That’s a lot of lost quality of life.
Now, for the first time, a group of researchers from the University of Waterloo in Canada actually studied how the back moves during sex, adding some hard data to support, and in some cases, debunk, the common advice doctors give their patients.
The first phase of this research focused on how the spine moves in a normal, healthy male during sex. To do this, lead researchers, Natalie Sidorkewicz, MSc, and Stuart McGill, M. PhD, recruited 10 heterosexual couples who did not have back pain.
Then they wired them with reflective sensors and told them to “move as naturally as possible” in five different sexual positions: two versions of the missionary position, two versions of the “doggy-style” position, and “spooning” or side-lying (the most common position recommended for people with back pain).
The researchers analyzed the data and identified the positions that were most “spine-sparing”—involving less movement—for different types of back pain.
Some people—and this is more common with age—experience back pain when they sit or bend forward. This is “flexion-intolerant” back pain. The best position for the flexion-intolerant is the quadruped or a missionary position with the male on his hands.
A second type of back pain is called “extension-intolerant,” which means that lying on the back or stomach is painful. For this type of back pain, spooning may be a better position.
For some people, any movement causes back pain, and for these “motion-intolerant” types, sex remains challenging. In general, however, movement (and pain) is lessened when it is shifted to the hip and knee, as in the quadruped position when the female is on her elbows.
With any of these positions, small adjustments—whether a person is on elbows or hands, for example—significantly changes the amount of back movement involved.
The best option for the person not controlling the movement (the females in this study) is to keep the spine in a neutral position, by supporting the small of the back with a pillow in the missionary position, for example.
A chart illustrating the best position for different types of pain is here.
Future research will focus on female back movement during sex and how the spine is affected by orgasm. The researchers also want to study the effect of various positions for actual back pain sufferers.
All this is the beginning of good news for people with back pain. Previously, medical recommendations have relied on “conjecture, clinical experience, or popular media resources,” according to the University of Waterloo study. Hard data is a welcome addition.
Researchers also hope their work will spark more dialog between patients and health care providers about sex, now that practitioners have real research to refer to in discussion with patients with back pain.
Long, long ago, when humankind first stood up on two feet, some bit of engineering seems to have gone missing. As a result, back pain is practically programmed into the human condition. The lucky ones may experience temporary pain from strained muscles, but for many, back pain can involve severe and constant pain from malfunctioning disks, nerve issues, bone issues, and a host of other maladies.
Unfortunately, nothing saps enjoyment and energy from life like pain. Whether intermittent or chronic, back pain can lay the sufferer, literally, flat on his or her back. Sex, obviously, becomes an early casualty. A 2008 survey found that most people who suffer from back pain have less sex, and they don’t enjoy it much. They say the pain has affected their relationships, but they don’t tend to talk about it either with their partners or their doctors. (And apparently, their doctors don’t bring up the issue of sex, either.)
There are ways to work around this state of affairs, however, from communicating with your partner and your doctor to experimenting with positions that might make intercourse more comfortable. One doctor even says that sex can actually help ease back pain by “mobilizing ‘stuck’ segments in the spine” and by releasing “feel good” endorphins in the brain. Not to mention returning a sense of intimacy and normalcy to the relationship. So, nurturing a sense of intimacy in your most important relationship is probably worth working on, right?
We’ve beaten this drum before, but communication is critical. First, it’s important to talk to your doctor. Do you have a diagnosis? Do you know what’s causing your back pain? If pain, depression, or fear is affecting your sex life, your doctor may well have some advice, from changing the dosages of your medication to suggesting positions that might alleviate pain.
Second, talk to your partner. Chronic pain is hard to understand if you’re not experiencing it. It feels like the “not now, dear, I have a headache” routine. It feels like rejection or at least avoidance.
If you’ve been avoiding sex, clear the air with your partner. You both need to express how you feel. Are you afraid that sex will hurt your back even more? That you’re somehow “damaged goods”? Does the pain sap your energy? Do you feel depressed? Listen to your partner's fears and frustrations, too. If the conversation is too difficult, maybe you and your partner should discuss it with a therapist. The good news is that, with some courage and experimentation, intimacy and intercourse don’t need to be held hostage to back pain.
Take it slow. Prepare yourself. Take a warm bath to relax muscles. Plan your rendezvous for a time of day when you tend to feel good. Take your pain meds. Set the mood (candles, incense, music). Good sex is as much about the ambience as about acrobatics anyway.
Plan your positions. Depending on the type of back pain you experience, different positions will help ease your pain. Use firm pillows for support under the small of your back, under your neck or head, under your knees—wherever it feels comfortable.
Those with herniated discs tend to feel better when the spine is extended (arched). Use a pillow under your back for the missionary position or have your partner sit on a chair while you straddle. Both these positions tend to keep your back straight or slightly arched.
For those with spinal stenosis, on the other hand, slightly flexing (humping) the back feels better. Keep your knees pulled toward you in the missionary position or drape your legs over your partner’s shoulders. Both positions keep the spine arched.
Try lying on your side. Or lie on the side of the bed with your legs dangling off the side. Just be sure you’re well-supported on a firm surface. Use the pillows wherever you need more support. The rule of thumb is that the partner without the pain should do the work. Take is slow, and if something hurts, stop!
Do kegels. Besides strengthening your pelvic floor muscles, which is good for sex, this exercise also develops your core musculature, which is good for your back.
A highly recommended book specifically dealing with this issue is Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain, by physical therapist Lauren Andrew Hebert.