Sex and Back Pain

Sex and Back Pain

Eight out of every 10 people experience back pain at some time in their lives, and an estimated 35 million Americans are hurting at any given moment. For many, this pain can interfere with a healthy sex life and lead to relationship problems.

A booklet and video, both entitled Sex and Back Pain, have been written and produced by Lauren Andrew Hebert, a physical therapist, to help individuals and couples find solutions to the physical, emotional - and sexual - challenges resulting from back pain. The video and book in tandem offer an easy-to-understand method for altering your positions to make sex more enjoyable.

Though the book and video might be useful, you should first get a medical examination to diagnose your problem. Once you've done that, follow your doctor's advice.

To understand the types and causes of back pain first requires a quick anatomy lesson. The spine is composed of 24 small bones, called vertebrae, that are stacked on top of each other. They meet at facet joints, which are very sensitive and easily sprained. The vertebrae each have a hollow core through which the spinal cord passes. A complex network of nerves serving the entire body spreads out from the spinal cord from between the vertebrae. The spaces between the vertebrae are filled by disks, which are tough fibrous sacs filled with a jelly-like substance that act as shock absorbers for the spine.

Injury and stress can lead to pulled muscles, damaged joints, bulging or ruptured disks and/or pinched nerves. Though there are myriad reasons for and descriptions of back pain, they can be placed into four broad categories as follow:

• Brittle Back, which is an advanced state of painfulness that tolerates very little movement of any kind
• Flexion Principle, which simply means that it hurts less to bend forward (flexion) and hurts more to bend backward
• Extension Principle, which means that it hurts less to bend backward (extension) and more to bend forward
• One-Sided Back Pain, which means back problems affect only one side of the spine

For each of these conditions, the video and booklet describe positions that can help make sex more enjoyable for the partner with back pain. Hebert suggests that any sexual activity can be made more pleasurable by preceding it with a gentle massage, a hot bath or shower, or the application of ice. Those techniques relax the muscles and ease pain. Hebert admits that certain techniques may not be right for everyone. "If you find yourself not liking some of the suggestions we make, that's fine," the video explains. "You may have tried something similar and found it unpleasant, but try to keep an open mind and be ready to try something new - even if you think it odd or unusual. It may end up being very enjoyable, and it may help you avoid back pain."

Techniques Described

Brittle back pain offers the most serious challenge. Hebert suggests that a person with this condition should lay on his or her back on a firm surface with pillows supporting the knees and head. Some find it comfortable to have a small hand towel rolled or folded and placed under the lower back. A position with both partners on their sides also is comfortable for some. The partner with the brittle back should take a passive role in love-making, with the other partner proceeding to introduce stimulation in a very relaxed, non-rushed manner. "Actual genital intercourse may not be tolerated by some people with a very brittle back," Hebert says. "These people need to use other sexual techniques that do not risk their back." Those techniques could include touching, massage, oral sex, mutual masturbation and other erotic play.

A person with Flexion Principle back pain wants to find positions that allow for the forward bending of the back. For a woman with this kind of back pain, comfortable positions may include the missionary position with her legs bent toward her chest. Another position involves sitting on the edge of a chair or sofa while her partner kneels between her legs to stimulate or enter her. For a man with this type of back pain, the missionary position may not be tolerated. He may be more comfortable entering his partner from behind as they both kneel on the bed. Or, she can kneel on the edge of the bed, facing in, while he enters from behind - being able to bend forward as he stands.

A person with Extension Principle back pains will want to use positions that support the arching of the lower back. To help a man with this type of back pain, a woman can bend her knees toward her chest while in the missionary position, or she can straddle him while he lies on his back with a pillow under his lower back or sits in a sturdy chair. A woman with this type of back pain may feel more comfortable lying on her stomach with a pillow under her chest, allowing her partner to enter her from behind. The woman may sit on her partner's lap as he sits in a chair, so she can control the position of her lower back and her movement.

Persons with one-side back pain generally feel better in any position in which they can bend one leg, or with both partners lying on their sides.

The Key is Communication

Because pain is invisible, it is often hard for a partner to understand what his or her partner is experiencing, Hebert said. "Back pain starts as a physical symptom, but when the pain is prolonged or severe, it frequently leads to emotional complications like depression, anger and frustration," states one passage from the video. These same symptoms can show up in the partner of the pain sufferer. "This tension between you and the people around you, which is caused by physical pain, can have a negative impact on your relationship." One wife of a man with back pain urges partners to communicate with each other "because the person who is not injured is feeling pain in the same kind of frustrating way that the injured person is feeling it." Another woman said she felt "a certain amount of resentment" toward her partner because she thought "maybe this was an excuse not to be close to me." Trying different positions suggested by Hebert was "a mutual experience of exploration that resulted in our having a sexual relationship like we had never had before."

A counselor on the video reminds partners to "understand ahead of time that you will experience difficulties and frustrations." She urges partners to plan their response to pain so it won't take them by surprise and lead to more anger and frustration. Hebert sums it up this way: "You can use relaxed attitudes, more open communications and new approaches to enjoying sex - not only to recover what you have lost but also to build a better sex life than you had before your back problem!"