By Ian Kerner, Ph.D., LMFT
An estimated eight out of ten Americans will suffer from back pain at some point in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It's no surprise that can have big effects on what goes on in your bedroom: whether a temporary strain slows you down or a more serious injury halts sex altogether.
We don't have good statistics on the number of people who eschew sex because of back pain, mainly because many people don't like to talk about sex with their doctors. But it stands to reason that back troubles can make sex a pain, too.
"Being in pain can make it more difficult to concentrate on pleasurable sensations, which in turn can make it more difficult to become aroused and have an orgasm," explains Florida-based sex therapist Rachel Needles. "Depending on the dose and type, pain medication can also interfere with arousal and orgasm in both men and women."
Fortunately, there are steps you can take to deal with the situation. Here are some ways to enjoy intimacy without back pain:
Talk about it. Back pain can be tricky because people often look fine, even if they feel terrible. That's all the more reason to keep your partner in the loop.
"The most important thing is to be open with your partner and have ongoing discussions about how the pain is interfering with sexual intimacy," says Needle. "This will help the partner in pain to not just avoid sex, but instead to team up with their partner to find ways for sex to be more comfortable and enjoyable."
Work it out. Dr. Maureen O'Leary, a specialist in orthopaedic injuries and neuromusculoskeletal impairments, guides clients through exercises designed to stretch and strengthen muscles.
"I'm also a big fan of Pilates, which is very effective at strengthening the muscles in the abdomen and torso that help support the back," she says.
Yoga may help, too: "I personally have recurrent lower back issues and have found that practicing yoga several times a week, especially right before sex, helps tremendously," says sex and marriage therapist Shellie M. Selove.
An experienced instructor, personal trainer or physical therapist can explain specific exercises and stretches that target the area of your back that's problematic.
Make adjustments. It makes sense that, depending on the location of your pain, some sexual positions will be more and less comfortable than others. "People with lower back problems like sciatica or a herniated disc tend to feel more pain when bending forward, while those with spinal stenosis may find bending backward to be more painful," explains O'Leary.
Let your body be your guide. If lying on your back hurts, you may want to be on top during sex, or vice versa. Side-by-side or spooning positions can take pressure off the back.
Experiment by placing a pillow under your lower back, stomach, knees or neck to see if the extra support helps, or try an angled pillow to make certain positions more comfortable, suggests sex educator Stephanie Mitelman.
Explore other forms of intimacy. "It's so important to touch and be touched by your partner," says Needles. Taking a hot bath or shower or getting a massage can help loosen tense muscles before sex.
Even better, they can be fun, connecting forms of foreplay: treat your partner to a soapy shower, or trade gentle massages to get in the mood. If intercourse seems like it might be too painful, make foreplay the main attraction, or focus on other forms of intimacy, such as cuddling, kissing, oral or manual stimulation, or simply sharing a fantasy.
Most causes of back pain eventually resolve with time and proper care. Whether you choose to make some adjustments in the bedroom or decide to make rest your priority, there's no need to banish intimacy altogether. Take this opportunity to connect and communicate with your partner, both inside the bedroom and out.