If you or your significant other is suffering from back or neck
pain, you know that sex is one of the first activities to be put
at the bottom of the list of things to do. This is a very common
problem and one that is infrequently discussed or written about
for people with back or neck pain. The reasons for this closed mouth
attitude are multiple. People who are suffering with it feel that
they may be the only ones having the problem and therefore embarrassed
to talk about it, even with the doctor. Some doctors do not feel
comfortable with the subject, or may not even recognize it as a
Sexuality is an integral part of normal and healthy relationships.
It need not be the first thing abandoned when you are bothered by
a flare-up of your neck or back pain. If you have chronic pain,
it should not prevent you from enjoying this part of your relationship.
To over simplify the problem, there are basically 3 components
of sexual functioning. All 3 must be in working order for things
to function normally. First and foremost are the emotional and psychological
aspects of sexuality. If you are depressed, angry, frustrated, preoccupied
or uninterested, you are unlikely to enjoy a sexual experience.
If you are preoccupied with your performance you may not be able
to function as you would wish. This article is not meant to be an
in-depth examination of the psychological aspects of sexuality.
If you are experiencing any of the above and are not able to resolve
them with your partner, discuss it with your primary care physician
or seek help from a licensed psychiatrist, psychologist or mental
health clinic. Most problems are successfully and rapidly resolved.
The second key components of sexuality are the physiological and
anatomical ones. These refer to your equipment and wiring. If they
are not working normally, you will not be unable to function normally.
This is not to say that you will not be able to enjoy sex, but that
it will be different. For example, men with spinal cord injuries
are not able to obtain to maintain erections without assistance,
yet they are able to have intercourse and achieve orgasm. The nerve
connections, or wiring, must be intact from the brain to the sexual
organs and they must get an adequate blood supply in order for things
to proceed "normally". There are a very large number of medical
conditions that can affect sexuality in this fashion. These include
but are not limited to diabetes, heart disease, prostatism, vascular
disease, and the pain from compression of a nerve. If you have the
desire and are free of pain yet are not able to function, then you
should be thoroughly examined by a physician to look for a medical
Thirdly, many people have the desire, and the equipment and wiring
are fine, but are unable to enjoy sex because they are not able
to get into a comfortable position due to neck or back pain. Many
conditions of the spine can make certain positions uncomfortable.
These are usually easily overcome with some thought and experimentation.
The general rule is "If it hurts do not do it". Positions that are
not comfortable in your day-to-day activities will not be comfortable
during sex either. Do not be afraid to experiment, there is no right
or wrong, normal or abnormal.
The following is a general outline of some of the more common back
diagnoses and their symptoms. Along with the position diagrams,
try to use these examples as a 'jumpimg off point' to guide you
through an evaluation of what works and what does not.
- Your back or legs hurts when you sit, bend or stoop. You feel
better standing, walking, sitting in a recliner or lying with
your back supported. These symptoms are usually caused by disc
disease such as internal disc disruption, annular tears, central
disc herniations and or sprains and strains . Acute disc herniations
and 'sciatica' will some times act similarly. Flexing the low
back worsens symptoms. This means bending it forward. The symptoms
may be relieved by straightening or by extending, bending the
spine backwards. In these situations you will be more comfortable
with your low back in a neutral, which is straight, or extended
position. This can be accomplished in the following ways. Any
of the following also apply to your neck and arm symptoms. Be
very careful in positioning your neck in extension, this can increase
pressure on your spinal cord. Just remember one simple rule. "If
it hurts, do not do it."
- Your back or legs hurt when you stand, walk or reach over head.
You feel better sitting, reclining and in certain positions lying
down. Spinal stenosis, spinal arthritis, facet joint disease,
sprains and strains, deconditioning and soft tissue diseases,
may cause these symptoms. Acute disc herniations and 'sciatica'
will some times act similarly. These conditions tend to be worsened
by extension of the spine and relieved by flexion or the neutral
position. This can be accomplished in the following ways. Any
of the following also apply to your neck and arm symptoms. Just
remember one simple rule: "If it hurts, do not do it."
As you and your partner embark on this adventure to make sex more
enjoyable, remember that this can be emotionally charged and potentially
frustrating. Take your time and start slowly. If your partner is
the one in pain, offer to start with a hot bath or shower together.
Most conditions respond favorably to gentle massage with some warm
oil. The massage works to decrease pain, relax the muscles and mind,
and can be stimulating. Share your feelings and enjoy.
What follows are some positions which may be more comfortable for
The female back patient with
back problem lies supine and comfortably on the floor or bed with
hips and knees bent. Pillows or towels may be used for support.
Her partner without back pain is on top being more active, but cautious
The woman with back problem
lies supine in a comfortable position supported by pillows or towels.
Her hips and knees are bent and relaxed over her partner. He enters
her while facing her, with minimal stress to his or her back.
The patient with back pain
can lie supine on the floor or bed with appropriate supports, pillows
or towels for comfort. The patient should be relatively passive
and reduce stress to his back. His partner without back problem
is on top and is taking a more active role.
The patient with the back
problem lies in the supine position on the floor or bed with appropriate
supports, pillows or towels for comfort. His back is protected and
immobile. His partner without back problem is on top and is taking
a more active role.
With certain spine problems (ususally non-disc related), sitting
may be more comfortable during sex. This sitting position may allow
more sensuous caressing; however, careful coordination by the partners
A woman with a back problem,
especially disc related, may be more comfortable in the prone position.
When she lies in the prone position, on her stomach, the lumbar
spine is in extension, which puts less stress on her discs. The
degree of back extension can be adjusted using pillows or cushions
under the chest or abdomen.
Patients with back problems
other than disc disease may be more comfortable when sitting. There
may be less pain during sex by adjusting the posture and movements.
Excessive spine movements can be avoided by careful coordination
with your partner. This position often allows more intimate caressing
A woman may rest on her arms
and knees while her partner is positioned posteriorly. While kneeling,
the partners' knees should be padded for appropriate height and
comfort. A woman with back pain should assume a more passive but
Please do not try these sexual position without your doctor
present. Just kidding - but Watch Your Back!!