Sex and Back Pain: A Work-around Primer

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.

Sex after Heart Disease: Good for the Body, Good for the Heart

Heart disease is a sobering reminder of mortality. After a heart attack or surgery, you live with a new reality. Maybe you’re faced with dietary restrictions or lifestyle changes or a new pharmaceutical regimen. Probably you’re more conscious of your breathing and your heart rate. With all the preoccupations and adjustments that accompany heart disease, sex can become a low priority. Maybe you’re afraid that intercourse will damage your newly fragile heart or actually trigger a heart attack. Or maybe it’s hard even to be interested in sex.

After a heart attack, it’s important to resume normal activities and to feel connected to people and life. What better way to feel vital and connected than to make love with your most intimate companion? Generally, the issues that stifle your sex life after a heart attack or surgery have to do with fear, depression, medication, and lack of communication with the doctor.

First, let’s address the persistent myth that sex can cause a heart attack. Studies repeatedly show that, if you can walk up a flight of stairs or carry a 20-pound bag of groceries into the house, you’re fit enough for sex. If you’ve passed the stress tests and are cleared to resume normal activity, what better activity than sex? Sure beats doing the laundry.

If you continue to worry, air your concerns with your doctor. An eye-opening study conducted at the University of Chicago revealed that doctors frequently neglect to talk with patients about their sex lives following a myocardial infarction, and that this tendency was particularly pronounced with female patients. (Less than half the men and less than one-third of women received instructions about sex when they were discharged from the hospital.) Patients who didn’t receive guidance from their doctors about sex were less likely to be sexually active in the year following their heart attack. So if the doctor doesn’t advise you about sex, please initiate the conversation yourself!

Depression commonly follows on the heels of heart disease, and women are more likely to become depressed than men. And both depression and many antidepressant drugs are likely to suppress sexual interest, leaving you between a rock and a hard place, sexually speaking. The good news is that depression after heart surgery or a heart attack usually resolves itself in about three months.

Other medications, such as beta-blockers that lower blood pressure and regulate heart rate, have also been linked with depression and sexual dysfunction. Again, your doctor may be able to adjust dosages or switch medication if necessary.

Finally, the good news is that sex is good for you emotionally and physically. It’s like a gentle, pleasurable workout. And anything you can do to improve your overall health--exercising, losing weight, stopping smoking--will improve your heart health and, incidentally, the quality of your sexual life.

Breathing Problems (COPD) and Sex: Take My Breath Away

When you exercise, you need more oxygen. Sex is like a light exercise—you need more oxygen then, too. For people with chronic obstructive pulmonary disease (COPD), such as asthma, emphysema, or chronic bronchitis, that breathing space may be hard to come by. Further complicating the physical condition is the emotional fear of not being able to breathe.

Taken together, these emotional and physical limitations present an obstacle to the carefree sex of former days. But just as you develop new ways to accomplish other daily activities, you can continue to enjoy a fulfilling sex life. You just have to make adjustments. Such as:

Stay in shape. Heard this before? To enjoy the highest quality of life possible, you need to be as healthy as possible. This means to continue to exercise and to maintain a healthy weight. Discuss ways to improve your health with your doctor. See if there’s a pulmonary rehab program in your area where you can learn safe ways to exercise. Your quality of life will be better, and so will the quality of your sex life.

Prepare the environment. For those with allergies or lung conditions, the bedroom is the most important area to keep clean and allergen-free. That means no fragrances, smoke, pet dander, or dust. Keep the mattress and pillows enclosed in allergenic covers. Use a HEPA filter on the vacuum and consider using one in the room itself.

Prepare yourself. In order to enjoy these intimate encounters, psychological preparation is as important as physical preparation. Think about what you need to feel secure during sex. How can you communicate with your partner if you begin to feel breathless? What can you do to approach intercourse as a pleasurable act without anxiety?

Some physical preparation can also help you feel safe and comfortable. Keep your inhalers at the bedside. Take a puff or two of your short-acting bronchodilator about 15 minutes before having sex. If you use oxygen, keep it bedside as well. Add tube extensions to the nasal canula so you have more wiggle room. Wait a couple hours after a meal to have sex.

Do it. Experiment with positions that take pressure off your chest—lying on your side or sitting on a chair, perhaps. Use pillows to help prop you up. Take it slow and easy—cuddling and touching are nice, too. Run a fan—cool air on your face can help ease breathing and diffuse any heat buildup in the area.

Use supplemental oxygen if you have to and stop if you get winded. Talk to your doctor about increasing the oxygen flow during sex.

Don’t overlook the many alternative ways to give and receive pleasure. You can use manual stimulation, for example, or use a vibrator on the clitoris and the underside of the penis.

When normal activities consume more energy, and fatigue is the shadow at your elbow, making love may seem like climbing Everest. But just as you find ways to accomplish those mundane tasks, it will be even more rewarding to find new ways to make love.

Sex and Arthritis: A New Kind of Reach

As we age, few of us escape periodic (or not-so-periodic) joint pain. While it may be possible to work around occasional pain and stiffness in a knee or elbow, when arthritis is constantly painful and potentially debilitating, everyday activities become newly challenging.

When replacing the cap on the toothpaste requires effort, having intercourse with our partner may seem like reaching for the moon. But just as we find new ways to replace caps and button blouses, we can reach for new ways to give and receive sexual pleasure. This may demand effort, experimentation, and communication, but the effort may also pay off in a deeper and more satisfying level of intimacy.

Here’s what leading rheumatologists and orthopedists have to say:

Be compassionate with yourself and your partner. Arthritis is painful, and pain is exhausting. Further, medications for arthritis may cause vaginal dryness and fatigue. Rest, patience, and vaginal lubricants can help.

Communicate. Your partner needs to understand the emotional and physical changes you’re experiencing, and you need to understand how your partner feels. Maybe you don’t feel sexy. Maybe your partner is afraid of hurting you during intercourse. It may help to begin the dialog in front of a doctor or other professional who can direct the conversation and also suggest possible remedies. Keep in mind that silence often looks a lot like rejection.

Plan ahead. Like other activities, a vital sex life will take more planning.

  • Schedule a “sex date” for a time of day when you tend to feel good.
  • Rest during the day—take a nap and avoid overexertion.
  • Take pain meds when they’re likely to be effective, about half an hour before your “date.”
  • Enjoy a warm bath (maybe with your partner) or use an electric blanket or heating pad to relax joints.
  • Do range-of-motion exercises to increase flexibility.
  • Look forward to the special time. Wear something sexy.

Experiment. Good sex leaves you and your partner feeling intimate, connected, and sexually satisfied, and there are many ways to skin this particular cat. Try new positions that take the pressure off painful areas and allow your partner to do more of the motion. Try using pillows for support or cushioning. Try massage or other loving touch. Oral sex or manual stimulation can be pleasurable. If your hands are affected, try using a vibrator on sensitive areas—the clitoris and the underside of the penis. Let your partner know what feels good—and what doesn’t. In fact, agree upon a signal that will stop the action if you experience pain.

When you have arthritis, life happens at a different pace—more tortoise than hare. But we all know how that story ended. As long as you keep moving, you’re winning.

I Will Overcome

Of course, we’d all love to enjoy good health and great sex until the day we die peacefully in our sleep. While we can control many aspects of our health, sometimes we just draw the short straw. Conditions like arthritis, heart disease, cancer, and lung problems can change our lives, our self-image, our relationships, what we’re capable of doing, and our experience of the world.

And without attention, our sex life with all its pleasure, tenderness, and intimacy can become collateral damage in the wake of illness. MiddlesexMD_BirdIt doesn’t have to be this way. In fact, it's a shame to forgo that shared pleasure and special bond just when it’s most needed. Despite the challenges, there’s no need to lay aside your sexual self in the face of health issues. And there’s every reason to make the effort to reinvent and reinvigorate the way you experience and express sex in your relationship.

In fact, illness could challenge you to communicate in ways you never did before. You might learn to enjoy the moment and be grateful for what’s left—or at least take less for granted. And the physical limitations of illness could lead you and your partner to become more sexually aware, patient, and experimental than ever before.

Recently, I attended a conference of the International Society for the Study of  Women’s Sexual Health (ISSWSH) at which a presentation on sexual rights reminded me of the many patients who try so hard to maintain normal lives in the face of life-changing health issues. This declaration of sexual rights is derived from a more extensive document first articulated by the IPPF.  Here are the sexual rights as they relate to you—mature women who are redefining their lives, including their sexual lives, in the face of illness. You have the right to

  • the highest level of sexual health you can attain
  • information related to sexual health
  • decide whether or not to be sexually active
  • consensual sexual relations that are free from abuse
  • a satisfying and pleasurable sex life

So, in the spirit of these sexual rights, I’ll explore some health conditions that can make sex—and life—challenging and suggest ways that might help bring back the joy of sex again. With education and commitment, you can still enjoy the highest level of sexual health possible. Despite limitations, you can express your sexual self with confidence and vitality.

(If there's a health issue in your life that you'd like to read more about, let me know!)