A healthy sex life keeps you happy and lowers stress.  If you suffer from back pain, you may find that sex is no longer pleasurable and leaves you feeling sore and unsatisfied.  Fortunately, there are ways to modify sex positions so that you can continue to be intimate with your partner without feeling worse afterwards!

Before you can choose a position that is right for you it is important to understand what type of back pain you have. 

Below are three common types of back pain.  Start by deciding which type sounds similar to the symptoms you experience and then check out the modified positions which will be best for you.  Not everyone fits exactly into these groups, so if you are unsure just ask your physiotherapist to advise you.

Some may be more or less comfortable, so play around and see which positions work best for you and your partner.

One of the most common types of low back pain is discogenic pain (meaning coming from the intervertebral disc).  With discogenic pain it is commonly worse with any activities that cause you spine to flex, for example bending, lifting, sitting, and rising.  Pain may also be aggravated by anything that increases the pressure within your abdomen, such as coughing, sneezing, or straining. Discogenic pain is usually relieved with positions where your lower back is in extension (with an arch in it), for example standing, walking, lying on your stomach, or back arches (as seen in the picture).

Find the best sex positions for discogenic pain.

Other common causes of back pain are facet joint pain, arthritis and spinal stenosis. This type of pain is commonly aggravated by extension of your lower back from activities such as walking, standing, arching backwards or lying on your stomach.  This pain is generally eased with flexion acitivies such as sitting, bending forwards or hugging your knees to your chest. 

Find the best sex positions for facet joint pain, arthritis and spinal stenosis.

Pain from the sacroiliac joint (SIJ) is less common and usually occurs after pregnancy or following trauma to the joint.  Trauma may be due to a fall or from repetitive loading during sports, such as cross country running. If you have pain from your SIJ it usually starts from lower down in your back (below your 5th lumbar vertebra) and may travel down one leg.  Unlike discogenic pain you shouldn’t experience any pins and needles or numbness with this type of pain. The pain is commonly aggravated by prolonged standing or walking, standing on one leg or standing and twisting. 

Find the best sex positions for sacroiliac joint (SIJ) pain.

For any type of back pain remember, take it slow, relax, and be as passive as possible during sex while you have pain.  If you are still too sore, you can still maintain intimacy with gentle massage, touching, kissing or oral sex.

Finally, it is important to know that following an episode of back pain you may have some difficultly recruiting your pelvic floor muscles.  Weak pelvic floor muscles can lead to incontinence.  Strengthening these muscles not only improves continence but also enhances sexual activity and can help your back pain.  Your pelvic floor muscles work during sex and strengthening them can increase the intensity of your orgasms!  So why wouldn’t you want to keep them nice and strong?

Strengthening pelvic floor muscles can be easy, but if you’re having difficulty you are best to see a womens health physiotherapist who specialises in pelvic floor retraining.

For more information check out the book Sex and Back Pain by expert physiotherapist Lauren Andrew Hebert. 

By Katy Street, BPhty, Cert. MDT, PG Dip (Musculoskeletal Physiotherapy), MPNZ, MNZMPA, MSPNZ

Musculoskeletal Physiotherapist & director at Auckland Physiotherapy

www.aucklandphysiotherapy.co.nz