Louise Chang, MD
When it comes to your sex life, low back pain can have serious impact. You may start avoiding bedroom encounters for fear of triggering more pain, and if your partner gets no explanation for your seeming loss of interest, your relationship may feel strained, too.
That’s why people with chronic back pain should bring sexual problems into the open, with their partner and with an understanding doctor who can help, says Michael R. Marks, MD, MBA, a spokesman for the American Academy of Orthopaedic Surgeons.
Sexual trouble related to back pain “is probably more common than physicians think and for patients to admit to,” Marks says. It’s still a bit of a taboo subject, but during 25 years of practice as an orthopaedic surgeon, he discusses the issue routinely with his patients, he says.
While a few patients will volunteer that back pain interferes with sexual intimacy, most won’t broach the subject, he says. “I think that there’s a lot of embarrassment about it.” But many are relieved to be able to finally talk about it, says Marks.
Still, many doctors don’t ask, he says, so patients might need to take the first step. “If your physician may not quite know how to broach the subject, it’s OK for you to,” he says.
Those with sexual problems related to chronic back pain often have disk disease or arthritis in the spine, but patients who are recovering from back surgery may also struggle.
But no type of chronic back pain rules out having an active sex life, Marks says.
As for back pain and sex difficulties between partners, “It’s something that’s really important to discuss,” Marks says. Over the years, his patients have confided that they are reluctant to tell their partners that they can’t have sex because it hurts too much or that they want to change longstanding sexual positions to ease the pain.
Chronic back pain can also lead to moodiness or depression. “When you’re depressed, it’s hard to perform,” Marks says.
When a couple starts having less sex without any discussion, not only the relationship, but a sense of trust, erodes. One of Marks’ patients who failed to explain that back pain caused his loss of interest discovered to his dismay that his partner suspected him of having an affair.
Sometimes, not only does a back patient fear pain, but a partner also worries about hurting the person during sex, according to Lauren Hebert, DPT, OCS, a physical therapist in Dixfield, Maine, and author of Sex and Back Pain. “[Fear] can be just as disabling,” he says.
In contrast, when partners are open about the problems, they can find alternatives to keep sex enjoyable.
Planning can make sex better. If your back is sore, taking a pain reliever before sex (as with any physical activity) can help, Marks says. He recommends an NSAID, but other non-narcotic pain relievers are fine, too.
If you have muscle spasms in the back, a hot shower before sex is a good idea, Marks says. “Sex can be a physical sport. If you’re taking cold muscles in spasm and going through vigorous activity, you could aggravate it.”
Try new positions
Besides taking a relaxing shower before sex, you could also try icing the troubled area afterward, Marks says. “Icing relieves any overstimulation of the muscles, any excessive stretching or anything like that -- just like an athlete after competing winds up icing whichever body part they’ve had problems with,” Marks says.
To make sex more comfortable, “[Couples] may need to modify the positions that they’re in,” Marks says.
That takes knowing your own body. Some people, such as those with disc problems, feel more pain when they bend forward, Hebert says.
For these people, the best positions allow the lower back to feel supported and relaxed, experts say. “Usually, the person with the back problem is going to find that they’re going to want to be on the bottom,” Marks says. “The key is, you want to make sure your back is in a well-supported position. It may be that you need to put a pillow underneath your back,” he says. A pillow in the small of the back will support the lumbar region. Placing pillows underneath the knees to make them slightly bent also takes pressure off the back, he says.
“In essence, you have the ability to still have sex,” he says, “but you may not be as vigorous as you would be otherwise.”
Others have more pain when they lean backward, typically those with arthritis or spinal stenosis, Hebert says. When they lean or hunch forward, their pain eases. This group may find that a side-by-side position works better. For example, a man with back pain will lie on his side, with his partner lying on her side with her back to him. Then he can enter from behind. He can control the position of his back, including being able to bend slightly forward.
Hebert says that physical therapy can help someone with chronic back pain improve flexibility and stability of the spine. “They should…see a physical therapist who is expert at spinal mechanics,” Hebert says. “[The physical therapist] will show them stretches and strengthening exercises that will build ability of the spine to move, to assume positions, and to stabilize themselves in those positions.”
Sometimes, back pain doesn’t happen during sex, but occurs later, Hebert says. “You can be doing something wrong, you can be doing too much of something, and the pain will be encountered in a delayed manner. You have to look out for that.” Limit sexual activities to a safe level of intensity, he says.
During sex, “mild discomfort may be acceptable,” he says, but not stronger pain.
If back pain strikes during sex, stop right away, Marks says. “It’s no different from the person who’s got back pain and says, ‘I only have a few more games to finish the tennis set. You do that -- your recovery time’s going to be even longer.”
A couple can always try again on a day when back pain has improved.
SOURCES:Michael R. Marks, MD, MBA, spokesman, American Academy of Orthopaedic Surgeons, vice president of business development, Norwalk Hospital, Norwalk, Conn.Lauren Hebert, DPT, OCS, physical therapist, Dixfield, Maine; author of Sex and Back Pain.
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