If you or your partner are among the 35 million people who have back pain, you know that back pain can disrupt your sexual relationship. Sex is an important part of the intimacy between couples and attitudes about sex, rejection and our self-image when we just don't feel up to a sexual encounter can haunt us for a long time.

This is an important article by Dr. Corners. Most important is the recognition of the inhibitory effect of pain and the fear of worsening any spinal condition with sexual activity. In most cases, an understanding about the condition and the advice from a doctor will help alleviate the fear and allow safe activities.

Some important facts:
(1) Disc Degeneration and herniations are usually made more painful with spinal flexion (bending forward/ sitting).

(2) Spinal Stenosis is usually aggravated by extending/ arching the back. Knowledge of these two facts and the specific diagnosis can aid in recommendations for positions to avoid and alleviation of fear.

—Todd Albert, MD

What can you do?
Sex is supposed to be pleasurable for both partners and the fear of hurting yourself or your partner inhibits the spontaneous joy that you probably felt before your developed. But what can you do about it? Most couples, when one or the other is restricted by back pain, will eventually get around to realizing that back pain does not automatically mean no more sex. What it does mean is that you will need to make some accommodations to the pain and/or the fear of it. It also means you will need to talk about sex in a slightly different way.

Having a sound diagnosis will give you some guidelines about your physical limits.
Let's back up for a second and begin with a very strong suggestion. Because pain has both a psychological component and a physical component, getting a sound diagnosis is critical to putting your mind at rest about what is wrong.

After you know the diagnosis, involve your doctor or physical therapist in a frank discussion about the 'dos and don'ts' about sex. Maybe it is an uncomfortable subject for you. However, people talk more openly about sex today. You should tap into your doctor's experience. In a perfect world, the doctor would open the discussion for you, but sometimes you may have to initiate the conversation. Ideally, your partner should be present to share their questions and concerns.

Keep in mind, the health of your back depends on many dynamic factors. Your symptoms may change over time, so you may need to periodically work with your health care provider throughout the recovery stages. A word of caution! It is common to feel better, overdo it and experience a flare up of back pain. We call this the 'whoopee effect' and it can happen to anyone. Just remember to gradually increase your activity level as you gradually improve.

As I mentioned earlier pain has two parts.
The physical aspect is the actual stimulation of the nerve, similar to a toothache, a herniated disc pressing on a nerve. The subjective or psychological part relates to how it feels to you and includes attitudes such as fear. For example, fear the pain will worsen or last forever; fear about what it means to be chronically disabled; and fear about what you believe your partner thinks about your pain and how you are coping with your condition.

Talk about It.
At the top of your agenda there needs to be a frank discussion about your pain limits and sexual expectations. It is a mistake to believe that your partner understands what you feel. It is your responsibility to communicate those limits as clearly as possible. It is your partner's responsibility to listen and try to understand.

Pain is invisible and subjective.
This means your pain is unique to you. People have described their pain as a chronic aching sensation localized in the lumbar area to a hot poker feeling that travels down one or both legs. Whatever words you use, try to explain the pain, the causes (position, certain movements, or whatever), and what feels good or comfortable for you.

Obviously, if it hurts 'don't do it' is good advice. But why do some positions and techniques hurt more than others? It may require gentle experimentation to find out what works. Usually, 'gentle' is the best way to start.

Starting Off Right
You might want to begin lovemaking with a massage, or placing ice on the painful area. A warm shower together might help too. A warm shower relaxes the muscles.

Here are some sexual positions that can help you enjoy a pain-free experience.

For Males:

1. Lie on a firm surface and use pillows to support your head and knees.
2. You might like to try placing a small rolled towel under your lower back.
3. Try a side-by-side position.
4. Place a pillow under your lower back while your partner straddles you on top.
5. You can also sit in a sturdy chair instead of lying down.

For Females:

1. Try the missionary position with the legs bent toward the chest.
2. Sit on the edge of a chair and have your partner kneel between your legs for entry.
3. Rear entry may also be more comfortable for women with back pain. Try it kneeling on the bed or lying on your belly with a pillow under her chest.
4. Sit on your partner's lap facing away from him as he sits in a chair.

In terms of maximizing sexual pleasure, it is very important to stress that all you really need is your imagination, the willingness to experiment, and be open to new areas of intimacy. But it all begins with willingness to try. You just may find the lemon of back pain can be turned into the lemonade of new sources of mutual pleasure.