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Sex and Back Pain

Eileen (not her real name) was embarrassed and shy to ask me about her low back pain that she had been managing with my help and her desire to resume sexual activity with her husband. She blurted out, “Do you think I’ll ever be able to make love to my husband again?” I inquired why she wasn’t currently engaged in sexual intercourse and she proceeded to tell me that the one position she was told to be safe for her back, side-lying (spooning) while having sex was causing her pain. After further discussion and helping her see that she had many other positions to use she could resume safe and comfortable sex without fear of hurting herself. I have seen this type of fear in many patients over the years and it need not be there.


Back pain problems are very common as you may already know from your first-hand experience with back pain yourself or you have seen that many of my columns deal with low back pain and how to manage it properly. Not only can back pain be devastating for a person dealing with work and leisure activities, but it can also play havoc on our personal lives. For many people, like Eileen, intimacy in the bedroom takes a back seat to low back pain.



Researchers from the University of Waterloo have found that certain positions are better than others for keeping different kinds of back pain at bay. They have even thrown out the long-held belief that spooning (lying sideways curled back to front) is the only pose for back-saving sex. There is no one position safe for everyone. Someone may find relief in one position that causes pain for someone else. Dr. Sidorkewicz, the lead author of this Canadian study found that both men and women employ a lot of spinal motion during sex and if their spine is in pain during sex, they need to create the movements from their hips and knees. She uses the missionary position as an example, if the woman, lying on her back were to put a cushion under the curvature of her spine, she may experience less pain because her spine is moving as much. The researchers also found that kneeling behind one’s partner during intercourse can prevent back pain caused by too much flexion or extension of the spine in one or both partners. More movement should come from the hips and knees allowing the back to not move as much.


Over the years I have had many patients ask for help in figuring out what positions can be safe for them during sex. It is men as much as women who need help in protecting their back. It is a shame when just one night of love-making can result in weeks of back pain. So many just decide to abstain. I have great news for those of you that are in this vicious cycle. You can resume back saving sex without hurting yourself or your partner.


Another study, Sexuality and sexual adjustment of patients with chronic pain, found that sexual problems are common in chronic pain patients. Patients who reported symptoms of depression and distress had more sexual problems. This then asks the question, What comes first, the chronic pain causing the depression and distress and then the sexual problems or does the sexual problems cause the distress and depression which can then lead to chronic pain. I have seen it both ways and each patient requires a unique set of skills to help resolve. Depression and low back pain is directly linked and well supported in the research that treating depression is a primary concern. One should see the primary care provider if this is the case and a referral to a psychologist may be appropriate. When being treated for musculoskeletal pain, many of our patients have a great deal of worry and anxiety around how they move. A physical therapist can help you get back to a normal and healthy movement.


Lauren Andrew Hebert, PT wrote, Sex and Back Pain: Advice on restoring comfortable sex lost to back pain. It was first published in 1987 and is still one of the most widely used books to educated patients with back pain safe ways to resume sexual activity. I use this book in my clinic as it is a well put together text with tasteful pictures that can be used for reference.


If you suffer from pelvic region pain at any time, or during or after sexual intercourse you should seek out a physical therapy referral from your physician and see a pelvic pain specialist. There are several physical therapy clinics in town that have PTs specializing in Pelvic Rehabilitation and they are highly skilled in the treatment of a vast array of pelvic issues such as any pelvic region pain, urinary incontinence, prenatal and postpartum pain, and low back pain associated with pregnancy. I will dedicate a full column on managing pelvic pain in the future.

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