Can I have sex if my back hurts?
Sex positions and tips for lower back pain
(approx 2 min read)
Statistics
Around 35% of the public have had their sex life disrupted by back pain, however there is not much discussion or advice readily available.
You can still have sex if it is within your pain tolerance, and this article gives tips and positions for more comfortable sex.
Choose a partner who values your wellbeing over their own ego.
Which movements are best for back pain?
When your back hurts, it can be a real mood killer. Arching your back, bending forwards or repetitive movements can aggravate your back throughout daily life so sex can be a little difficult. There’s no one magic position or solution for this, but this article aims to educate you and give you some tips and tricks to find what works best for you.
Back pain may be :
Flexion intolerant (FI) : It doesnt like bending forwards
Extension intolerant (EI): It doesnt like bending backwards
When deciding which movements are best for the back, we need to know whether it is EI or FI. Discs, joints and muscular pain can all sit in either category, so it is less about what is wrong, and more about which movement it prefers.
Most studies have been done on ongoing, episodic back pain and it may be best to sit it out if you’re in the middle of an acute flare up.
Pros and Cons:
Pros:
(Good) sex has a multitude of benefits around the body and for reducing pain.
Stimulates the release of oxytocin, dopamine and endorphine hormones that reduce pain.
Stretches and activates different muscle groups
Stimulates blood flow, helping to keep muscles healthy and promotes lymph drainage.
Cons:
Sex can however have less beneficial outcomes:
Irritation and compression of spinal joints and nerves
Sex you are not enjoying does not release the pain reducing chemicals
Some pain medications reduce libido and sexual function, especially opioids such as Co-codamol and Codeine.
Preparation:
Communication is key. - Discuss verbal/non-verbal cues with your partner(s) for swapping and changing position. Sex is best if everyone is enjoying themselves so be confident in yourself if you need to change
Massage - Massage helps relax the muscles before and after. Slow, gliding movements are best using your finger pads or palms. Check in with your partner if the pressure is okay.
Morning sex - Discs are at their fullest and most likely to be injured in the first 90 mins of waking. Late night and evening may also be sore and tired so either take it easy through the day (no cleaning or lifting), or have the sex a little earlier.
Foreplay - Do not underestimate foreplay. More foreplay means more warm up for the muscles, more endorphins and dopamine, and less load on your back. Games like the 3 minute game from Harry Faddis, or tantra are great for exploring intimacy without loading your back.
Positions:
These are the most researched positions for lower back pain but as with any posture or movement, there can be too much of a ‘good’ thing. If you feel like youre getting uncomfortable or fatigued then switch up to something that works better, and revisit the original position once its had a rest.
Studies by McGill and Sidorkewiz into both male and female back pain examined these positions for load on the lower back: QUADRUPED (fQUAD1 and fQUAD2 where the female is supporting her upper body with her elbows and hands, respectively), MISSIONARY (fMISS1 and fMISS2 where the female is minimally and more flexed at the hips and knees, respectively), and SIDELYING.
Missionary: Great all rounder for backs. Person on bottom can bend their knees up so feet are flat on bed to reduce the load further. Person on top can support weight on hands rather than elbows.
Quadruped (Doggy): Good for the givers back, especially if the bottom is supporting weight on elbows rather than hands. Avoid over-arching your back if you are the receiver to reduce spinal compression.
Spooning: Sidelying, either facing each other or big/little spoon this is great for receivers back, not so good for givers back.
Tips:
Bend your knees: Bending your knees up will reduce the load on your back, regardless of the position!
Pillows: Your normal position, but supported. IE. Pillows supporting your pelvis if bottom in doggy.
Toys: Bringing toys in is a great way to reduce the stress on your back but still having fun.
Aftercare :
Ice: 1-3 x Ice for 20 mins to reduce any inflammation around the spine and discs, especially useful if you have sciatica or trapped nerves
Stretch: 3-5x20 cat camel stretches. 4-10x 20 second child pose
Hot shower: Heat relaxes the muscles, so if you’re feeling achy either side of the spine, then the hot water can help to relax this.
Summary:
There is no single solution, but with a good understanding and advice, and good understanding and communication with your partner you can find what works best for you. And some people find they have relief from pain symptoms when they have sex.
References:
Ferrari S, Vanti C, Frigau L, et al. Sexual disability in patients with chronic non-specific low back pain-a multicenter retrospective analysis. J Phys Ther Sci. 2019;31(4):360-5. doi:10.1589/jpts.31.360
Ajo R, Segura A, Inda MD, et al. Erectile dysfunction in patients with chronic pain treated with opioids. Med Clin (Barc). 2017;149(2):49-54. English, Spanish. doi:10.1016/j.medcli.2016.12.038
Sidorkewicz N, McGill SM. Male spine motion during coitus: implications for the low back pain patient. Spine (Phila Pa 1976). 2014 Sep 15;39(20):1633-9. doi: 10.1097/BRS.0000000000000518. PMID: 25208042; PMCID: PMC4381984.
Sidorkewicz N, McGill SM. Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Eur Spine J. 2015 Mar;24(3):513-20. doi: 10.1007/s00586-014-3626-y. Epub 2014 Oct 24. PMID: 25341806.
