Back pain is one of the most common medical problems, affecting 8 out of 10 people at some point during their lives. Back pain that becomes chronic is associated with significant disability. Chronic back pain interferes with work and leisure activities. Men and women with chronic back pain often suffer from depression and anxiety, resulting from the decline in quality of life. What also suffers in people with chronic back pain, as well as those with only occasional but annoying back symptoms, is sex. Although back pain generally does not directly affect the ability to function sexually and enjoy arousal and orgasm, the sex lives of people who suffer from back pain and their partners may become significantly challenged.

For one thing, pain is a libido crusher. Pain is exhausting and debilitating, and fatigue dampens sex drive, particularly if the sexual activity is anticipated to hurt. Additionally, many of the medications used to treat chronic pain affect sexual drive and decrease sensations of arousal. Finally, being in chronic pain often affects the partner relationship, which further reduces sexual interest in both partners. A common pattern of interaction is that the partner in pain may not initiate or be responsive to sex. The partner is reluctant to initiate sex for various reasons including not wanting to feel rejected, not wanting to cause pain in the partner or simply wanting to avoid conflict. As a result, the partner in pain feels rejected and disconnected.

Much can be done to improve intimate and sexual relations in a couple affected by chronic pain. For one thing, many people who suffer pain are surprised to learn that sexual pleasure can act as an analgesic and actually alleviate pain. Sex triggers endorphins that ease pain and relax the body so that sleep becomes easier. So while intercourse in certain positions may be painful for someone with back pain, mutual touching or intercourse in alternative positions may be painless and satisfying. Here are several tips to put your back “back” under the sheets with your partner:

Start talking: Rather than allow the subject of sex to go by the wayside, communicate your feelings to your partner. If you are too worn out or in pain to consider having sex, even saying something to your partner like “I wish I felt better so that we could have sex” will prevent your partner from feeling rejected and will keep the subject alive. Communicate to your partner what would feel good to you. If it is your partner with the back pain, ask what might feel good and what you could do to help improve comfort.

Try planning ahead for sex: If you know you are planning to have sex, get plenty of rest so you are less tired and more refreshed. If you are particularly stiff in the mornings, afternoon or evening sex is preferable. Take an analgesic an hour before.

Warm up: Do those stretching exercises your physical therapist taught you prior to having sex so you will be less likely to have muscle spasms. A nice warm bath or long shower is a good idea prior to lovemaking, and inviting your partner to join you may help set the mood. If your partner is the one in pain, offer a relaxing back massage. Most conditions respond favorably to gentle massage with some warm oil. The massage works to decrease pain, relax the muscles and mind, and can be stimulating.

Be creative with positions: Have sex on a firm surface that provides stability rather than a soft mattress that offers poor support. Use plenty of pillows to support your knees and head. Try using a rolled towel under your lower back. Avoid positions of swayback, such that if you are used to the missionary position and it’s the man with the bad back, try woman on top. Use a sturdy chair and make love sitting instead of lying down. Most importantly, listen to your body, and if it hurts, don’t do it.

This resource may be helpful: Chronic back pain and sexuality